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Chang-Chien J, Kuo ML, Tseng YL, Huang HY, Tsai HJ, Yao TC. Differential effects of long- and short-term exposure to PM 2.5 on accelerating telomere shortening: from in vitro to epidemiological studies. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 281:116650. [PMID: 38964064 DOI: 10.1016/j.ecoenv.2024.116650] [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: 01/24/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
Exposure to air pollutants has been associated with DNA damage and increases the risks of respiratory diseases, such as asthma and COPD; however short- and long-term effects of air pollutants on telomere dysfunction remain unclear. We investigated the impact of short- and long-term exposure to fine particulate matter with an aerodynamic diameter below 2.5 μm (PM2.5) on telomere length in human bronchial epithelial BEAS-2B cells, and assessed the potential correlation between PM2.5 exposure and telomere length in the LIGHTS childhood cohort study. We observed that long-term, but not short-term, PM2.5 exposure was significantly associated with telomere shortening, along with the downregulation of human telomerase reverse transcriptase (hTERT) mRNA and protein levels. Moreover, long-term exposure to PM2.5 induced proinflammatory cytokine secretion, notably interleukin 6 (IL-6) and IL-8, triggered subG1 cell cycle arrest, and ultimately caused cell death. Long-term exposure to PM2.5 upregulated the LC3-II/ LC3-I ratio but led to p62 protein accumulation in BEAS-2B cells, suggesting a blockade of autophagic flux. Moreover, consistent with our in vitro findings, our epidemiological study found significant association between annual average exposure to higher PM2.5 and shortening of leukocyte telomere length in children. However, no significant association between 7-day short-term exposure to PM2.5 and leukocyte telomere length was observed in children. By combining in vitro experimental and epidemiological studies, our findings provide supportive evidence linking potential regulatory mechanisms to population level with respect to long-term PM2.5 exposure to telomere shortening in humans.
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Affiliation(s)
- Ju Chang-Chien
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Ling Kuo
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Microbiology and Immunology, Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei, Taiwan
| | - Yu-Lung Tseng
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Yi Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; College of Life Sciences and Medicine, National Tsing Hua University, Hsinchu, Taiwan.
| | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
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Zuo S, Sasitharan V, Di Tanna GL, Vonk JM, De Vries M, Sherif M, Ádám B, Rivillas JC, Gallo V. Is exposure to pesticides associated with biological aging? A systematic review and meta-analysis. Ageing Res Rev 2024; 99:102390. [PMID: 38925480 DOI: 10.1016/j.arr.2024.102390] [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: 04/02/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Exposure to pesticides is a risk factor for various diseases, yet its association with biological aging remains unclear. We aimed to systematically investigate the relationship between pesticide exposure and biological aging. METHODS PubMed, Embase and Web of Science were searched from inception to August 2023. Observational studies investigating the association between pesticide exposure and biomarkers of biological aging were included. Three-level random-effect meta-analysis was used to synthesize the data. Risk of bias was assessed by the Newcastle-Ottawa Scale. RESULTS Twenty studies evaluating the associations between pesticide exposure and biomarkers of biological aging in 10,368 individuals were included. Sixteen reported telomere length and four reported epigenetic clocks. Meta-analysis showed no statistically significant associations between pesticide exposure and the Hannum clock (pooled β = 0.27; 95 %CI: -0.25, 0.79), or telomere length (pooled Hedges'g = -0.46; 95 %CI: -1.10, 0.19). However, the opposite direction of effects for the two outcomes showed an indication of possible accelerated biological aging. After removal of influential effect sizes or low-quality studies, shorter telomere length was found in higher-exposed populations. CONCLUSION The existing evidence for associations between pesticide exposure and biological aging is limited due to the scarcity of studies on epigenetic clocks and the substantial heterogeneity across studies on telomere length. High-quality studies incorporating more biomarkers of biological aging, focusing more on active chemical ingredients of pesticides and accounting for potential confounders are needed to enhance our understanding of the impact of pesticides on biological aging.
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Affiliation(s)
- Shanshan Zuo
- University of Groningen, Campus Fryslân, Department of Sustainable Health, Leeuwarden, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology and Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands.
| | | | - Gian Luca Di Tanna
- University of Applied Sciences and Arts of Southern Switzerland, Department of Business Economics, Health and Social Care, Lugano, Switzerland
| | - Judith M Vonk
- University of Groningen, University Medical Center Groningen, Department of Epidemiology and Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Maaike De Vries
- University of Groningen, University Medical Center Groningen, Department of Epidemiology and Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Moustafa Sherif
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, United Arab Emirates
| | - Balázs Ádám
- United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, United Arab Emirates
| | - Juan Carlos Rivillas
- Imperial College London, MRC Centre Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, London, United Kingdom
| | - Valentina Gallo
- University of Groningen, Campus Fryslân, Department of Sustainable Health, Leeuwarden, the Netherlands
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Duseikaite M, Gedvilaite G, Mikuzis P, Andrulionyte J, Kriauciuniene L, Liutkeviciene R. Investigating the Relationship between Telomere-Related Gene Variants and Leukocyte Telomere Length in Optic Neuritis Patients. J Clin Med 2024; 13:2694. [PMID: 38731223 PMCID: PMC11084964 DOI: 10.3390/jcm13092694] [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: 04/07/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Optic neuritis (ON) is a condition marked by optic nerve inflammation due to various potential triggers. Research indicates a link between telomeres and inflammation, as studies demonstrate that inflammation can lead to increased telomere shortening. Aim: We aimed to determine the associations of telomere-related telomeric repeat binding factor 1 (TERF1) rs1545827, rs10107605, and telomeric repeat binding factor 2 (TERF2) rs251796 polymorphisms and relative leukocyte telomere length (LTL) with the occurrence of ON. Methods: In this research, a total of 73 individuals diagnosed with optic neuritis (ON) were studied and the control group included 170 individuals without any health issues. The DNA samples were obtained from peripheral blood leukocytes, which were purified using the DNA salting-out technique. Real-time polymerase chain reaction (RT-PCR) assessed single-nucleotide polymorphisms (SNPs) and relative leukocyte telomere lengths (LTL). The data obtained were processed and analyzed using the "IBM SPSS Statistics 29.0" program. Results: Our study revealed the following results: in the male group, TERF2 rs251796 (AA, AG, and TT) statistically significantly differed between the long and short telomere group, with frequencies of 65.7%, 22.9%, and 2.0% in long telomeres, compared to 35.1%, 56.8%, and 8.1% in the short telomere group (p = 0.013). The TERF2 rs251796 CT genotype, compared to CC, under the codominant genetic model, was associated with 4.7-fold decreased odds of telomere shortening (p = 0.005). Meanwhile, CT+TT genotypes, compared to CC under the dominant genetic model, were associated with 3.5-fold decreased odds of telomere shortening (p = 0.011). Also, the CT genotype, compared to CC+TT, under the overdominant genetic model, was associated with 4.4-fold decreased odds of telomere shortening (p = 0.004). Conclusions: The current evidence may suggest a protective role of TERF2 rs251796 in the occurrence of ON in men.
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Affiliation(s)
- Monika Duseikaite
- Laboratory of Ophthalmology, Institute of Neuroscience, Lithuanian University of Health Sciences, Eivenių Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
- Faculty of Pharmacy, Lithuanian University of Health Sciences, Sukilėlių Pr. 13, LT-50166 Kaunas, Lithuania
| | - Greta Gedvilaite
- Laboratory of Ophthalmology, Institute of Neuroscience, Lithuanian University of Health Sciences, Eivenių Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
- Medical Faculty, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (P.M.); (J.A.)
| | - Paulius Mikuzis
- Medical Faculty, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (P.M.); (J.A.)
| | - Juste Andrulionyte
- Medical Faculty, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (P.M.); (J.A.)
| | - Loresa Kriauciuniene
- Laboratory of Ophthalmology, Institute of Neuroscience, Lithuanian University of Health Sciences, Eivenių Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
| | - Rasa Liutkeviciene
- Laboratory of Ophthalmology, Institute of Neuroscience, Lithuanian University of Health Sciences, Eivenių Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
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Schellnegger M, Hofmann E, Carnieletto M, Kamolz LP. Unlocking longevity: the role of telomeres and its targeting interventions. FRONTIERS IN AGING 2024; 5:1339317. [PMID: 38333665 PMCID: PMC10850353 DOI: 10.3389/fragi.2024.1339317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
Average life expectancy has been steadily increasing in developed countries worldwide. These demographic changes are associated with an ever-growing social and economic strain to healthcare systems as well as society. The aging process typically manifests as a decline in physiological and cognitive functions, accompanied by a rise in chronic diseases. Consequently, strategies that both mitigate age-related diseases and promote healthy aging are urgently needed. Telomere attrition, characterized by the shortening of telomeres with each cell division, paradoxically serves as both a protective mechanism and a contributor to tissue degeneration and age-related ailments. Based on the essential role of telomere biology in aging, research efforts aim to develop approaches designed to counteract telomere attrition, aiming to delay or reduce age-related diseases. In this review, telomere biology and its role in aging and age-related diseases is summarized along with recent approaches to interfere with telomere shortening aiming at well- and healthy-aging as well as longevity. As aging research enters a new era, this review emphasizes telomere-targeting therapeutics, including telomerase activators and tankyrase inhibitors, while also exploring the effects of antioxidative and anti-inflammatory agents, along with indirectly related approaches like statins.
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Affiliation(s)
- Marlies Schellnegger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- COREMED–Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Elisabeth Hofmann
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- COREMED–Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Martina Carnieletto
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- COREMED–Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- COREMED–Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
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Tesolato S, Vicente-Valor J, Jarabo JR, Calatayud J, Sáiz-Pardo M, Nieto A, Álvaro-Álvarez D, Linares MJ, Fraile CA, Hernándo F, Iniesta P, Gómez-Martínez AM. Role of Telomere Length in Survival of Patients with Idiopathic Pulmonary Fibrosis and Other Interstitial Lung Diseases. Biomedicines 2023; 11:3257. [PMID: 38137478 PMCID: PMC10741059 DOI: 10.3390/biomedicines11123257] [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: 11/21/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Interstitial lung diseases (ILDs) constitute a group of more than 200 disorders, with idiopathic pulmonary fibrosis (IPF) being one of the most frequent. Telomere length (TL) shortening causes loss of function of the lung parenchyma. However, little is known about its role as a prognostic factor in ILD patients. With the aim of investigating the role of TL and telomerase activity in the prognosis of patients affected by ILDs, we analysed lung tissue samples from 61 patients. We measured relative TL and telomerase activity by conventional procedures. Both clinical and molecular parameters were associated with overall survival by the Kaplan-Meier method. Patients with IPF had poorer prognosis than patients with other ILDs (p = 0.034). When patients were classified according to TL, those with shortened telomeres reported lower overall survival (p = 0.085); differences reached statistical significance after excluding ILD patients who developed cancer (p = 0.021). In a Cox regression analysis, TL behaved as a risk-modifying variable for death associated with rheumatic disease (RD) co-occurrence (p = 0.029). Also, in patients without cancer, ferritin was significantly increased in cases with RD and IPF co-occurrence (p = 0.032). In relation to telomerase activity, no significant differences were detected. In conclusion, TL in lung tissue emerges as a prognostic factor in ILD patients. Specifically, in cases with RD and IPF co-occurrence, TL can be considered as a risk-modifying variable for death.
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Affiliation(s)
- Sofía Tesolato
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain; (S.T.); (J.V.-V.)
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
| | - Juan Vicente-Valor
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain; (S.T.); (J.V.-V.)
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
| | - Jose-Ramón Jarabo
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
- Department of Surgery, Faculty of Medicine, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain
- Thoracic Surgery Service of the San Carlos Hospital, 28040 Madrid, Spain
| | - Joaquín Calatayud
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
- Department of Surgery, Faculty of Medicine, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain
- Thoracic Surgery Service of the San Carlos Hospital, 28040 Madrid, Spain
| | - Melchor Sáiz-Pardo
- Pathological Anatomy Service of the San Carlos Hospital, 28040 Madrid, Spain;
| | - Asunción Nieto
- Pulmonology Service of the San Carlos Hospital, 28040 Madrid, Spain;
| | | | - María-Jesús Linares
- Pulmonology Service of Alcorcon Foundation University Hospital, 28922 Madrid, Spain;
| | - Carlos-Alfredo Fraile
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
- Department of Surgery, Faculty of Medicine, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain
- Thoracic Surgery Service of the San Carlos Hospital, 28040 Madrid, Spain
| | - Florentino Hernándo
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
- Department of Surgery, Faculty of Medicine, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain
- Thoracic Surgery Service of the San Carlos Hospital, 28040 Madrid, Spain
| | - Pilar Iniesta
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain; (S.T.); (J.V.-V.)
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
| | - Ana-María Gómez-Martínez
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain; (J.-R.J.); (J.C.); (C.-A.F.); (F.H.); (A.-M.G.-M.)
- Department of Surgery, Faculty of Medicine, Complutense University, Ramón y Cajal Sq. (University City), 28040 Madrid, Spain
- Thoracic Surgery Service of the San Carlos Hospital, 28040 Madrid, Spain
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Reljic D, Koller A, Herrmann HJ, Ekici AB, Neurath MF, Zopf Y. Differential Effects of Very-Low-Volume Exercise Modalities on Telomere Length, Inflammation, and Cardiometabolic Health in Obese Metabolic Syndrome Patients: A Subanalysis from Two Randomized Controlled Trials. Antioxidants (Basel) 2023; 12:1847. [PMID: 37891926 PMCID: PMC10603979 DOI: 10.3390/antiox12101847] [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: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Oxidative stress (OS) and inflammation are features of metabolic syndrome (MetS) that can contribute to the shortening of telomere length (TL), a marker of cellular ageing. Research indicates that exercise can positively influence MetS-associated conditions and TL. However, the effects of low-volume exercise types on TL are still unknown. We investigated the impact of very-low-volume high-intensity interval training (LV-HIIT), one-set resistance training (1-RT), and whole-body electromyostimulation (WB-EMS) on TL, inflammation, and cardiometabolic indices in 167 MetS patients. Data were derived from two randomized controlled trials where patients were allocated to an exercise group (2 sessions/week, for 12 weeks) or a control group. All groups received standard-care nutritional weight loss counselling. TL was determined as the T/S ratio (telomere to single-copy gene amount). All groups significantly reduced body weight (p < 0.05), but the T/S-ratio (p < 0.001) only increased with LV-HIIT. OS-related inflammatory markers (C-reactive protein, interleukin-6, and lipopolysaccharide-binding protein) only decreased (p < 0.05) following LV-HIIT. The MetS severity z-score improved with LV-HIIT (p < 0.001) and 1-RT (p = 0.014) but not with WB-EMS. In conclusion, very-low-volume exercise modalities have differential effects on telomeres, inflammation, and cardiometabolic health. Only LV-HIIT but not strength-based low-volume exercise increased TL in MetS patients, presumably due to superior effects on OS-related inflammatory markers.
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Affiliation(s)
- Dejan Reljic
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Adriana Koller
- Institute of Genetic Epidemiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Hans J. Herrmann
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Yurdagül Zopf
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
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