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Arisi TOP, da Silva DS, Stein E, Weschenfelder C, de Oliveira PC, Marcadenti A, Lehnen AM, Waclawovsky G. Effects of Cocoa Consumption on Cardiometabolic Risk Markers: Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:1919. [PMID: 38931273 PMCID: PMC11206597 DOI: 10.3390/nu16121919] [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: 05/21/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to examine the effect of dietary intake of cocoa on anthropometric measurements, lipid and glycemic profiles, and blood pressure levels in adults, with and without comorbidities. METHODS The databases used were MEDLINE (PubMed), EMBASE, Web of Science, Cochrane, LILACS, and SciELO. The eligible studies were randomized clinical trials (RCTs) involving adults undergoing cocoa consumption (cocoa extract or ≥70% cocoa dark chocolate) for ≥4 weeks that evaluated at least one of the following markers: body weight, body mass index (BMI), waist/abdominal circumference, total cholesterol, LDL-c, triglycerides, HDL-c, blood glucose, glycated hemoglobin (HbA1c), and systolic and diastolic blood pressure (SBP/DBP). RESULTS Thirty-one studies were included, totaling 1986 participants. Cocoa consumption showed no effects on body weight, BMI, waist circumference, triglycerides, HDL-c and HbA1c. Yet, there was a reduction in total cholesterol (-8.35 mg/dL, 95% CI -14.01; -2.69 mg/dL), LDL-c (-9.47 mg/dL, 95% CI -13.75; -5.20 mg/dL), fasting blood glucose (-4.91 mg/dL, 95% CI -8.29; -1.52 mg/dL), SBP (-2.52 mmHg, 95% CI -4.17; -0.88 mmHg), and DBP (-1.58 mmHg, 95% CI -2.54; -0.62 mmHg). CONCLUSIONS The consumption of cocoa showed protective effects on major cardiometabolic risk markers that have a clinical impact in terms of cardiovascular risk reduction.
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Affiliation(s)
- Tainah O. P. Arisi
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
| | - Diego Silveira da Silva
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
| | - Elana Stein
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
| | - Camila Weschenfelder
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
| | - Patrícia Caetano de Oliveira
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
| | - Aline Marcadenti
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
- Instituto de Pesquisa Hcor (IP-Hcor), Hcor, São Paulo 04005-909, SP, Brazil
- Faculdade de Saúde Pública, Universidade de São Paulo (FSP-USP), São Paulo 01246-904, SP, Brazil
| | - Alexandre Machado Lehnen
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
| | - Gustavo Waclawovsky
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre 90620-001, RS, Brazil; (T.O.P.A.); (D.S.d.S.); (E.S.); (C.W.); (P.C.d.O.); (A.M.); (G.W.)
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Zielinsky P, Alves DR, Foresti JDÁ, Guimarães DB, Zucatti KP, Vian I. Maternal supplementation with docosahexaenoic acid does not cause constriction of fetal ductus arteriosus: randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:586-591. [PMID: 38214544 DOI: 10.1002/uog.27584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Docosahexaenoic acid (DHA) is recommended routinely in pregnancy to promote fetal development. DHA has anti-inflammatory activity, but its effects on the fetal heart and circulation are unknown. This study aimed to investigate whether maternal DHA supplementation in the third trimester affects maternal prostaglandin levels and fetal ductus arteriosus flow dynamics. METHODS This was a double-blind randomized controlled trial with parallel groups conducted between 2018 and 2021. Pregnant women aged over 18 years with a normal fetus at 27-28 weeks' gestation showing no cardiac/extracardiac anomalies or ductal constriction were eligible for the trial. Women consuming substances with a known inhibitory effect on prostaglandin metabolism, such as non-steroidal anti-inflammatory drugs and polyphenol-rich foods, were excluded. The intervention group received oral supplementation of omega-3 with 450 mg/day of DHA for 8 weeks and the placebo group received capsules of soy lecithin for 8 weeks. Anthropometric measurements, assessment of polyphenol and omega-3 consumption, fetal morphological ultrasound examination, fetal Doppler echocardiographic examination and blood sample collection were performed at the start of the study and the latter two were repeated at follow-up. Prostaglandin E2 (PGE2) level and echocardiographic parameters were compared between the intervention and placebo groups and between baseline and follow-up. RESULTS A total of 24 participants were included in each group. After 8 weeks, there were no significant differences between the intervention and placebo groups in maternal serum PGE2 level or Doppler echocardiographic parameters of ductal flow. No case of ductus arteriosus constriction was observed. The expected intragroup changes in cardiac morphology, as a result of advancing gestation, were present. CONCLUSIONS Maternal DHA supplementation in the third trimester at a clinically recommended dose did not result in inhibition of PGE2 or constriction of the ductus arteriosus. These findings should be confirmed in postmarket surveillance studies with larger patient numbers in order to test the full safety profile of DHA and provide robust clinical reassurance. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
- Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - D R Alves
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - J D Á Foresti
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - D B Guimarães
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - K P Zucatti
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - I Vian
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
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Zielinsky P, Sulis NM, Martins CM, Zucatti KP, Bonamigo ER, Vian I. Fetal ductal constriction in the third trimester of pregnancy: a prevalence study. J Perinatol 2024; 44:444-445. [PMID: 38042943 DOI: 10.1038/s41372-023-01844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Paulo Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil.
- Department of Pediatrics, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2400-Santa Cecília/CEP 90035-003, Porto Alegre, Brazil.
| | - Natássia Miranda Sulis
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Cláudia Monster Martins
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Kelly Pozzer Zucatti
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Eduarda Rodrigues Bonamigo
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Izabele Vian
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
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Darby JRT, Williams GK, Cho SKS, Meakin AS, Holman SL, Quinn M, Wiese MD, Macgowan CK, Seed M, Morrison JL. Acute resveratrol exposure does not impact hemodynamics of the fetal sheep. Physiol Rep 2023; 11:e15749. [PMID: 37332034 PMCID: PMC10277215 DOI: 10.14814/phy2.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023] Open
Abstract
Babies born growth restricted are at an increased risk of both poor short-and long-term outcomes. Current interventions to improve fetal growth are ineffective and do not lower the lifetime risk of poor health status. Maternal resveratrol (RSV) treatment increases uterine artery blood flow, fetal oxygenation, and fetal weight. However, studies suggest that diets high in polyphenols such as RSV may impair fetal hemodynamics. We aimed to characterize the effect of RSV on fetal hemodynamics to further assess its safety as an intervention strategy. Pregnant ewes underwent magnetic resonance imaging (MRI) scans to measure blood flow and oxygenation within the fetal circulation using phase contrast-MRI and T2 oximetry. Blood flow and oxygenation measures were performed in a basal state and then repeated while the fetus was exposed to RSV. Fetal blood pressure and heart rate were not different between states. RSV did not impact fetal oxygen delivery (DO2 ) or consumption (VO2 ). Blood flow and oxygen delivery throughout the major vessels of the fetal circulation were not different between basal and RSV states. As such, acute exposure of the fetus to RSV does not directly impact fetal hemodynamics. This strengthens the rationale for the use of RSV as an intervention strategy against fetal growth restriction.
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Affiliation(s)
- Jack R. T. Darby
- Early Origins of Adult Health Research GroupUniSA: Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAdelaideAustralia
| | - Georgia K. Williams
- Preclinical, Imaging and Research LaboratoriesSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Steven K. S. Cho
- Early Origins of Adult Health Research GroupUniSA: Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAdelaideAustralia
- Univeristy of Toronto and The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Ashley S. Meakin
- Early Origins of Adult Health Research GroupUniSA: Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAdelaideAustralia
| | - Stacey L. Holman
- Early Origins of Adult Health Research GroupUniSA: Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAdelaideAustralia
| | - Megan Quinn
- Early Origins of Adult Health Research GroupUniSA: Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAdelaideAustralia
| | - Michael D. Wiese
- Centre for Pharmaceutical Innovation, UniSA: Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAdelaideAustralia
| | | | - Mike Seed
- Univeristy of Toronto and The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Janna L. Morrison
- Early Origins of Adult Health Research GroupUniSA: Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAdelaideAustralia
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Wen J, Guo X, Cai S, Xu D, Zhang G, Bai X. Fetal Ductus Arteriosus Premature Constriction. Int Heart J 2022; 63:722-728. [PMID: 35831144 DOI: 10.1536/ihj.21-723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the connections between the echocardiography indices of fetal ductus arteriosus premature constriction and newborn prognosis by analyzing 22 cases of spontaneous fetal ductus arteriosus premature constriction.An ultrasonic instrument was used to observe prenatal fetal heart state, combine clinical examination data and echocardiographic results after delivery, summarize the ultrasound manifestations and imaging characteristics, and analyze the prognosis of the fetus.In all cases, fetal ductus arteriosus premature constriction occurred in the third trimester of pregnancy (34 + 1 to 41 weeks), and no abnormality in extracardiac organs were observed. Seven neonates required respiratory support due to the accompanying severe tricuspid regurgitation. The remaining 15 neonates did not receive respiratory support, including 4 with severe tricuspid regurgitation, 5 with moderate regurgitation, and 6 with mild regurgitation. Significant differences were observed in the fetal right atrium size and tricuspid regurgitation severity between the neonatal respiratory support group and non-respiratory support group. Furthermore, there were statistical differences in the ductus arteriosus inner diameter and pulsation index between the two groups.The severity of fetal ductus arteriosus premature contraction accompanied by tricuspid regurgitation and right atrium enlargement can predict the immediate prognosis of the newborn and provide guidance for the clinical judgment of the timing of pregnancy termination.
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Affiliation(s)
- Jie Wen
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Xuedong Guo
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Shuping Cai
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Dong Xu
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Geer Zhang
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
| | - Xiaoxia Bai
- Department of Obstetrics, Women's Hospital, Medical School of Zhejiang University & Key Lab of Women's Reproductive Health Zhejiang
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Ma J, Cao H, Hong L, Liu J, Song X, Shi J, Zhang Y, Cui L, Zhang L, Xie M. Cardiac Function Assessment in Fetuses With Ductus Arteriosus Constriction: A Two-Dimensional Echocardiography and FetalHQ Study. Front Cardiovasc Med 2022; 9:868675. [PMID: 35958395 PMCID: PMC9360592 DOI: 10.3389/fcvm.2022.868675] [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: 02/03/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFetal ductal constriction (DC) is associated with excessive polyphenol-rich food (PRF) consumption during pregnancy. However, the effect of this hemodynamic change on fetal cardiac function still needs to be elucidated. Therefore, this study aimed to evaluate the cardiac function of fetuses with PRF-related DC and to describe serial observations of cardiac function changes.MethodsWe compared the traditional echocardiographic indices, including morphological, hemodynamic, and functional parameters, between study fetuses and controls. For global and segmental deformation analysis of the left and right ventricles, fetalHQ with the speckle-tracking technique was used to calculate sphericity index (SI), global longitudinal strain (GLS), fractional shortening (FS), fractional area change (FAC), etc. In addition, follow-up data were compared with the generalized linear model.ResultsA total of 60 DC fetuses and 60 gestational-matched controls were enrolled in our study, with 20 DC fetuses undertaking a follow-up echocardiogram after 2–3 weeks. Compared with controls, there was a distinct decrease in right ventricular GLS (RVGLS) (−13.39 ± 3.77 vs. −21.59 ± 2.51, p < 0.001), RVFAC (22.20 ± 9.56 vs. 36.01 ± 4.84, p < 0.001), left ventricular GLS (LVGLS) (−19.52 ± 3.24 vs. −23.81 ± 2.01 p < 0.001), and LVFAC (39.64 ± 7.32 vs. 44.89 ± 4.91, p = 0.004). For 24-segment FS analysis, DC fetuses showed lower FS in left ventricular (LV) segments 18–24, with no difference in LV segments 1–17. Right ventricular (RV) FS in segments 4–23 was also reduced in the DC group. The 24-segment SI analysis indicated significantly lower SI in DC than those in controls for LV segments 1–14 and RV segments 19–24. We found that the pulsatility index (PI) of ductus arteriosus (DA) was an independent variable for RVGLS (β = −0.29, p = 0.04). In 20 DC fetuses with follow-up echocardiograms, no obvious difference in myocardial deformation was found between the initial examination and follow-up data.ConclusionLeft and right ventricular performances were both impaired in DC fetuses, along with a series of morphological and hemodynamic changes. Although the state of DA constriction improved on second examinations, cardiac function was not completely restored.
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Affiliation(s)
- Jing Ma
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Haiyan Cao
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Liu Hong
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Juanjuan Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoyan Song
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiawei Shi
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yi Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Cui
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Li Zhang,
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Mingxing Xie,
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Proença ICT, Miri MR, Marinho JP, Bock PM, de Abreu TM, Pinto MS, Blembeel AS, Ferreira AS, Andrades M, da Rosa Araújo AS, Funchal C, Pochmann D, Dani C. Gestational purple grape juice consumption does not change fetal ductus arteriosus constriction in Wistar rats. Birth Defects Res 2022; 114:525-535. [PMID: 35484956 DOI: 10.1002/bdr2.2018] [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: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/07/2022]
Abstract
Grape juice consumption may influence the early occurrence of ductal constriction during pregnancy, since the consumption of foods rich in polyphenols can be linked to the premature constriction of the ductus arteriosus. This study aimed to evaluate the effect of purple grape juice consumption during gestation on fetal ductus arteriosus closure, prostaglandin levels, and oxidative stress markers in Wistar rats. We divided 18 pregnant rats into four groups: a control group (C), a single-dose grape juice group (SDGJ), a two-dose grape juice group (TDGJ) of 7 μl/g body weight per day, and an indomethacin group (I). Blood was collected on gestational day (GD) 0, 14, and 20. Prostaglandin levels were measured, and the livers and hearts were removed from the mothers and fetuses for oxidative stress analysis; histology of the fetal ductus arteriosus was performed. Prostaglandin levels (pg/ml) at GD 20 were (C:1462.10 ± 314.61); (SDGJ:987.66 ± 86.25); (TDGJ:1290.00 ± 221.57), and (I:584.75 ± 46.77). Fetal ductus arteriosus closure occurred only in the indomethacin group. Lipid peroxidation evaluated through thiobarbituric acid reactive substances (nmol/mg protein) in maternal livers was lower in the grape juice groups (C: 4.11 ± 0.76 nmol/mg protein), (SDGJ: 2.34 ± 0.36), (TDGJ: 1.52 ± 0.18), and (I: 4.20 ± 0.76). Sulfhydryls (nmol/mg protein) were lower in the TDGJ group (C:763.59 ± 61.38 nmol/mg protein), (SDGJ:978.88 ± 158.81), (TDGJ:385.32 ± 86.78), and (I:727.72 ± 49.12). Also, superoxide dismutase activity (USOD/mg protein) was higher in fetal hearts in this group: (C:5.29 ± 0.33), (SDGJ:4.48 ± 0.47), (TDGJ:7.35 ± 0.43), and (I:6.00 ± 0.18). We conclude that grape juice consumption in pregnancy does not induce ductus arteriosus closure in the fetus and presented potential antioxidant effects.
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Affiliation(s)
| | - Malena Rostirola Miri
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Jéssica Pereira Marinho
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | | | - Tamires Marques de Abreu
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Milene Santana Pinto
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Amanda Stolzenberg Blembeel
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Aimée Souto Ferreira
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Michael Andrades
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Cláudia Funchal
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Daniela Pochmann
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Caroline Dani
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
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Resveratrol and Reproductive Health. Life (Basel) 2022; 12:life12020294. [PMID: 35207581 PMCID: PMC8875092 DOI: 10.3390/life12020294] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 12/16/2022] Open
Abstract
Resveratrol (RSV), a plant-derived polyphenol, demonstrates broad-spectrum health benefits, including anti-proliferative, anti-inflammatory, antidiabetic, anti-ischemic and antioxidant effects. The aim of this review is to give an important heads-up regarding the influence of RSV as a phytoestrogen, RSV effects on most common pregnancy-related complications, as well as its impact on the embryogenesis, spermatogenesis, and women’s reproductive health. Considering the important implications of RSV on human reproductive health, this overview could provide a groundwork, encouraging more detailed research at the clinical level.
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Battistoni G, Montironi R, Di Giuseppe J, Giannella L, Delli Carpini G, Baldinelli A, Pozzi M, Ciavattini A. Foetal ductus arteriosus constriction unrelated to non-steroidal anti-Inflammatory drugs: a case report and literature review. Ann Med 2021; 53:860-873. [PMID: 34096417 PMCID: PMC8189142 DOI: 10.1080/07853890.2021.1921253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
Foetal ductus arteriosus (DA) constriction can be found in complex foetal heart malformations, but rarely as an isolated defect. Although many cases of DA constriction are usually related to Non-steroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake, other causes remain without an established aetiology and are referred to as idiopathic. Recently, a wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) showed a definitive effect upon the pathway of inflammation, causing DA constriction. We report a case of a premature DA constriction in a woman whose possible risk factor was identified in her maternal occupational exposure to solvents and a comprehensive literature review of 176 cases of NSAID-unrelated DA constriction. A 30-year-old Asian woman was referred to our institution at 33 gestational weeks and 0 days because of suspicion of premature DA constriction. The woman had no history of medication intake, including NSAIDs, alcohol, tobacco or polyphenol-rich-food consumption during pregnancy. A detailed foetal echocardiography revealed a normal cardiac anatomy with hypertrophic, hypokinetic and a dilated right ventricle due to right pressure overload, holosystolic tricuspid regurgitation, and, at the level of the DA, high systolic and diastolic velocities, indicating premature ductal restriction. The right outflow showed dilatation of the pulmonary artery with narrow DA. An urgent caesarean section was performed at 33 gestational weeks and 4 days due to worsening of DA PI and signs of right pressure overload, despite the interruption of exposure to solvents. We assume a relationship exists between premature DA constriction and a maternal occupational exposure to solvents. This hypothesis is reinforced by the presence of associated foetal malformations in in two of the patient's children. Further research is needed to confirm the role of exposure to solvents and toxic chemicals in the pathogenesis of DA constriction, also with experimental animal models.KEY MESSAGESMany cases of DA constriction are usually related to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake.A wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) can cause foetal DA constriction.Further investigation are needed to confirm the role of maternal exposure to solvents in the pathogenesis of DA constriction.
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Affiliation(s)
- Giovanna Battistoni
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Ramona Montironi
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Luca Giannella
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Baldinelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
| | - Marco Pozzi
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
| | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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Zielinsky P, MagalhÃes GA, Zurita-Peralta J, Sosa-OlavarrÍa A, Marinho G, Van Der Sand L, Sulis NM, Nicoloso LH, Piccoli A, Vian I. Improvement in fetal pulmonary hypertension and maturity after reversal of ductal constriction: prospective cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:420-427. [PMID: 33502049 DOI: 10.1002/uog.23599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/20/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To test the hypotheses that estimated mean pulmonary arterial pressure (MPAP) decreases and pulmonary vascular maturation, assessed by the ratio of pulmonary arterial flow acceleration time to ejection time (AT/ET ratio), increases after reversal of fetal ductus arteriosus constriction by reducing maternal intake of the causal agent (prostaglandin inhibitors, such as polyphenol-rich foods or non-steroidal anti-inflammatory drugs), and that these effects are independent of gestational age, which are inferences not yet demonstrated in the clinical setting. METHODS This was a prospective cohort study comparing Doppler echocardiographic ductal flow dynamics, MPAP and pulmonary arterial flow AT/ET ratio in third-trimester fetuses (≥ 28 weeks' gestation) with ductus arteriosus constriction, at the time of diagnosis and after 2 weeks of reduced maternal intake of prostaglandin inhibitors either by suspending the use of pharmacological agents with potential for prostaglandin inhibition or by restricting the consumption of polyphenol-rich foods. MPAP was estimated using the Dabestani equation (MPAP = 90 - (0.62 × AT)), and pulmonary vascular maturity was assessed using the AT/ET ratio, according to reported validation studies. Student's t-test was used for comparison of variables at diagnosis with those after reversal of ductal constriction. Change in MPAP and pulmonary AT/ET ratio between the two assessments was compared with the expected change in the same gestational period in normal fetuses based on reference curves of MPAP and pulmonary AT/ET ratio constructed in normal fetuses from healthy pregnant women at 19-37 weeks' gestation, encompassing the same gestational age range as the study group (28-37 weeks). RESULTS Seventy pregnancies with fetal ductus arteriosus constriction were included in the study. After 2 weeks of reduced maternal intake of prostaglandin inhibitors, normalization of mean systolic (change from 1.86 ± 0.34 m/s at diagnosis to 1.38 ± 0.41 m/s; P < 0.001) and diastolic (change from 0.41 ± 0.11 m/s to 0.21 ± 0.065 m/s; P < 0.001) ductal velocities and of mean pulsatility index (change from 1.99 ± 0.20 to 2.55 ± 0.42; P < 0.001) was demonstrated. MPAP decreased between the assessments (change from 66.7 ± 6.90 mmHg at diagnosis to 54.5 ± 6.70 mmHg after 2 weeks; P < 0.001) and mean pulmonary AT/ET ratio increased (change from 0.20 ± 0.06 to 0.33 ± 0.07; P < 0.001). Change in MPAP between diagnosis and after 2 weeks of reduced maternal intake of prostaglandin inhibitors was -12.2 ± 0.30 mmHg, which was 5.3-times higher than that in 305 normal fetuses over 2 weeks during the same gestational period (-2.3 ± 0.19 mmHg) (P < 0.001), and change in pulmonary AT/ET ratio between the two assessments was 0.13 ± 0.08, which was 8.7-times higher than that in normal fetuses in the same gestational period (0.015 ± 0.08) (P < 0.001). CONCLUSIONS Resolution of fetal ductal constriction is followed by a fall in MPAP and by an increase in pulmonary vascular maturity, to a significantly greater degree than is observed in normal fetuses in the same gestational-age period. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
- Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - G A MagalhÃes
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - J Zurita-Peralta
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | | | - G Marinho
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - L Van Der Sand
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - N M Sulis
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - L H Nicoloso
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - A Piccoli
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - I Vian
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
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11
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Zielinsky P, Martignoni FV, Markoski M, Zucatti KP, Dos Santos Marinho G, Pozzobon G, Magno PR, de Bittencourt Antunes V, Sulis NM, Cardoso A, Mattos D, Naujorks AA, von Frankenberg AD, Vian I. Maternal ingestion of cocoa causes constriction of fetal ductus arteriosus in rats. Sci Rep 2021; 11:9929. [PMID: 33976258 PMCID: PMC8113492 DOI: 10.1038/s41598-021-89309-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/20/2021] [Indexed: 01/13/2023] Open
Abstract
Maternal consumption of polyphenol-rich foods has been associated with fetal ductus arteriosus constriction (DAC), but safety of chocolate exposure in fetal life has not been studied. This experimental study tested the hypothesis that maternal cocoa consumption in late pregnancy causes fetal DAC, with possible associated antioxidant effects. Pregnant Wistar rats, at the 21st gestational day, received by orogastric tube cocoa (720 mg/Kg) for 12 h, indomethacin (10 mg/Kg), for 8 h, or only water, before cesaren section. Immediately after withdrawal, every thorax was obtained and tissues were fixed and stained for histological analysis. The ratio of the narrowest part of the pulmonary artery to the fetal ductus inner diameter and increased ductal inner wall thickness characterized ductal constriction. Substances reactive to thiobarbituric acid were quantified. Statistical analysis used ANOVA and Tukey test. Cocoa (n = 33) and indomethacin (n = 7) reduced fetal internal ductus diameter when compared to control (water, n = 25) (p < 0.001) and cocoa alone increased ductus wall thickness (p < 0.001), but no change was noted in enzymes activity. This pharmacological study shows supporting evidences that there is a cause and effect relationship between maternal consumption of cocoa and fetal ductus arteriosus constriction. Habitual widespread use of chocolate during gestation could account for undetected ductus constriction and its potentially severe consequences, such as perinatal pulmonary hypertension, cardiac failure and even death. For this reason, dietary guidance in late pregnancy to avoid high chocolate intake, to prevent fetal ductal constriction, may represent the main translational aspect of this study.
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Affiliation(s)
- Paulo Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil. .,Departament of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. .,Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 395 - Santana, Porto Alegre, CEP 90620-000, Brazil.
| | - Felipe Villa Martignoni
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil.,Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Melissa Markoski
- Basic Health Science, Federal University of Health Sciences of Porto Alegre, Avenida Sarmento Leite, 245, Porto Alegre, CEP 90050-170, Brazil
| | - Kelly Pozzer Zucatti
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Gabriela Dos Santos Marinho
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Gabriela Pozzobon
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Pedro Rafael Magno
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | | | - Natassia Miranda Sulis
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Alexandra Cardoso
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Daniel Mattos
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Alexandre Antônio Naujorks
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Anize Delfino von Frankenberg
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Izabele Vian
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
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12
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Domínguez-Perles R, Gil-Izquierdo A, Ferreres F, Medina S. Update on oxidative stress and inflammation in pregnant women, unborn children (nasciturus), and newborns - Nutritional and dietary effects. Free Radic Biol Med 2019; 142:38-51. [PMID: 30902759 DOI: 10.1016/j.freeradbiomed.2019.03.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
Abstract
The scientific background of perinatal pathology, regarding both mother and offspring, from the lipidomic perspective, has highlighted the possibility of identifying new, promising clinical markers of oxidative stress and inflammation, closely related to the normal development of unborn and newborn children, together with their application. In this regard, in recent years, significant advances have been achieved, assisted by both newly developed analytical tools and basic knowledge on the biological implications of oxylipins. Hence, in the light of this recent progress, this review aims to provide an update on the relevance of human oxylipins during pregnancy and in the unborn and newborn child, covering two fundamental aspects. Firstly, the evidence from human clinical studies and dietary intervention trials will be used to shed light on the extent to which dietary supplementation can modulate the lipidomic markers of oxidative stress and inflammation in the perinatal state, emphasizing the role of the placenta and metabolic disturbances in the mother and fetus. The second part of this article comprises a review of existing data on specific pathophysiological aspects of human reproduction, in relation to lipidomic markers in pregnant women, unborn children, and newborn children. The information reviewed here evidences the current opportunity to correct reproductive disturbances, in the framework of lipidomics, by fine-tuning dietary interventions.
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Affiliation(s)
- R Domínguez-Perles
- Group on Safety, Quality, and Bioactivity of Plant Foods, Department of Food Science and Technology, (CEBAS-CSIC), University Campus of Espinardo, Edif. 25, 30100, Murcia, Spain
| | - A Gil-Izquierdo
- Group on Safety, Quality, and Bioactivity of Plant Foods, Department of Food Science and Technology, (CEBAS-CSIC), University Campus of Espinardo, Edif. 25, 30100, Murcia, Spain.
| | - F Ferreres
- Group on Safety, Quality, and Bioactivity of Plant Foods, Department of Food Science and Technology, (CEBAS-CSIC), University Campus of Espinardo, Edif. 25, 30100, Murcia, Spain
| | - S Medina
- Group on Safety, Quality, and Bioactivity of Plant Foods, Department of Food Science and Technology, (CEBAS-CSIC), University Campus of Espinardo, Edif. 25, 30100, Murcia, Spain
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13
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Pedra SRFF, Zielinsky P, Binotto CN, Martins CN, Fonseca ESVBD, Guimarães ICB, Corrêa IVDS, Pedrosa KLM, Lopes LM, Nicoloso LHS, Barberato MFA, Zamith MM. Brazilian Fetal Cardiology Guidelines - 2019. Arq Bras Cardiol 2019; 112:600-648. [PMID: 31188968 PMCID: PMC6555576 DOI: 10.5935/abc.20190075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Simone R F Fontes Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.,Hospital do Coração (HCor), São Paulo, SP - Brazil
| | - Paulo Zielinsky
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
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14
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Dong C, Chen J, Harrington A, Vinod KY, Hegde ML, Hegde VL. Cannabinoid exposure during pregnancy and its impact on immune function. Cell Mol Life Sci 2019; 76:729-743. [PMID: 30374520 PMCID: PMC6632091 DOI: 10.1007/s00018-018-2955-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/10/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
Cannabinoids are the most commonly abused illicit drugs worldwide. While cannabis can be beneficial for certain heath conditions, abuse of potent synthetic cannabinoids has been on the rise. Exposure to cannabinoids is also prevalent in women of child-bearing age and pregnant women. These compounds can cross the placental barrier and directly affect the fetus. They mediate their effects primarily through G-protein coupled cannabinoid receptors, CB1 and CB2. In addition to significant neurological effects, cannabinoids can trigger robust immunomodulation by altering cytokine levels, causing apoptosis of lymphoid cells and inducing suppressor cells of the immune system. Profound effects of cannabinoids on the immune system as discussed in this review, suggest that maternal exposure during pregnancy could lead to dysregulation of innate and adaptive immune system of developing fetus and offspring potentially leading to weakening of immune defenses against infections and cancer later in life. Emerging evidence also indicates the underlying role of epigenetic mechanisms causing long-lasting impact following cannabinoid exposure in utero.
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Affiliation(s)
- Catherine Dong
- School of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Chemistry and Biochemistry, College of Arts and Sciences, University of South Carolina, Columbia, SC, 29208, USA
| | - Jingwen Chen
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, SC, 29208, USA
| | - Amy Harrington
- School of Pharmacy, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Chemistry and Biochemistry, College of Arts and Sciences, University of South Carolina, Columbia, SC, 29208, USA
| | - K Yaragudri Vinod
- Division of Analytical Psychopharmacology, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
- Emotional Brain Institute, Orangeburg, NY, 10962, USA
- Child and Adolescent Psychiatry, New York School of Medicine, New York, NY, 10016, USA
| | - Muralidhar L Hegde
- Department of Radiation Oncology, Institute for Academic Medicine and Research Institute, The Houston Methodist Research Institute (HMRI), 6550 Fannin St, Smith 08-077, Houston, TX, 77030, USA
| | - Venkatesh L Hegde
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, Columbia, SC, 29208, USA.
- Department of Radiation Oncology, Institute for Academic Medicine and Research Institute, The Houston Methodist Research Institute (HMRI), 6550 Fannin St, Smith 08-077, Houston, TX, 77030, USA.
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