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Feugray G, Miranda S, Le Cam Duchez V, Bellien J, Billoir P. Endothelial Progenitor Cells in Autoimmune Disorders. Stem Cell Rev Rep 2023; 19:2597-2611. [PMID: 37676423 DOI: 10.1007/s12015-023-10617-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
Circulating endothelial progenitor cells (EPCs) were first described in 1997 by Asahara et al. as "putative endothelial cells" from human peripheral blood. The study of endothelial progenitors is also intensifying in several pathologies associated with endothelial damage, including diabetes, myocardial infarction, sepsis, pulmonary arterial hypertension, obstructive bronchopneumopathy and transplantation. EPCs have been studied in several autoimmune diseases with endothelial involvement such as systemic lupus erythematosus, thrombotic thrombocytopenic purpura, antineutrophil cytoplasmic antibodies, vasculitis, rheumatoid arthritis, Goujerot-Sjögren and antiphospholipid syndrome. Factors involved in endothelial damage are due to overexpression of pro-inflammatory cytokines and/or autoantibodies. Management of these pathologies, particularly the long-term use of glucocorticoids and methotrexate, promote atherosclerosis. A lack of standardized assessment of the number and function of EPCs represents a serious challenge for the use of EPCs as prognostic markers of cardiovascular diseases (CVD). The objective of this review was to describe EPCs, their properties and their involvement in several autoimmune diseases.
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Affiliation(s)
- Guillaume Feugray
- UNIROUEN, INSERM U1096 EnVI, CHU Rouen, Department of General Biochemistry, Normandie University, F-76000, Rouen, France
| | - Sébastien Miranda
- UNIROUEN, INSERM U1096, CHU Rouen. Department of Internal Medicine, Normandie University, Rouen, France
| | | | - Jérémy Bellien
- UNIROUEN, INSERM U1096 EnVI, CHU Rouen, Department of Pharmacology, Normandie University, F-76000, Rouen, France
| | - Paul Billoir
- UNIROUEN, INSERM U1096, CHU Rouen. Department of Internal Medicine, Normandie University, Rouen, France.
- Normandy Univ, U1096, Rouen University Hospital, Vascular Hemostasis Unit, Rouen, France.
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Patnaik E, Lyons M, Tran K, Pattanaik D. Endothelial Dysfunction in Systemic Sclerosis. Int J Mol Sci 2023; 24:14385. [PMID: 37762689 PMCID: PMC10531630 DOI: 10.3390/ijms241814385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Systemic sclerosis, commonly known as scleroderma, is an autoimmune disorder characterized by vascular abnormalities, autoimmunity, and multiorgan fibrosis. The exact etiology is not known but believed to be triggered by environmental agents in a genetically susceptible host. Vascular symptoms such as the Raynaud phenomenon often precede other fibrotic manifestations such as skin thickening indicating that vascular dysfunction is the primary event. Endothelial damage and activation occur early, possibly triggered by various infectious agents and autoantibodies. Endothelial dysfunction, along with defects in endothelial progenitor cells, leads to defective angiogenesis and vasculogenesis. Endothelial to mesenchymal cell transformation is another seminal event during pathogenesis that progresses to tissue fibrosis. The goal of the review is to discuss the molecular aspect of the endothelial dysfunction that leads to the development of systemic sclerosis.
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Affiliation(s)
- Eshaan Patnaik
- Department of Biology, Memphis University School, Memphis, TN 38119, USA;
| | - Matthew Lyons
- Division of Rheumatology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA; (M.L.); (K.T.)
| | - Kimberly Tran
- Division of Rheumatology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA; (M.L.); (K.T.)
| | - Debendra Pattanaik
- Division of Rheumatology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA; (M.L.); (K.T.)
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Del Rio APT, Frade-Guanaes JO, Ospina-Prieto S, Duarte BKL, Bertolo MB, Ozelo MC, Sachetto Z. Impaired repair properties of endothelial colony-forming cells in patients with granulomatosis with polyangiitis. J Cell Mol Med 2022; 26:5044-5053. [PMID: 36052734 PMCID: PMC9549508 DOI: 10.1111/jcmm.17531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/04/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022] Open
Abstract
In patients with ANCA‐associated vasculitis, interactions between neutrophils and endothelial cells cause endothelial damage and imbalance. Endothelial colony‐forming cells (ECFCs) represent a cellular population of the endothelial lineage with proliferative capacity and vasoreparative properties. This study aimed to evaluate the angiogenic capacity of ECFCs of patients with granulomatosis with polyangiitis (GPA). The ECFCs of 13 patients with PR3‐positive GPA and 14 healthy controls were isolated and characterized using fluorescence‐activated cell sorting, capillary tube formation measurement, scratching assays and migration assays with and without plasma stimulation. Furthermore, three patients with active disease underwent post‐treatment recollection of ECFCs for longitudinal evaluation. The ECFCs from the patients and controls showed similar capillary structure formation. However, the ECFCs from the patients with inactive GPA exhibited early losses of angiogenic capacity. Impairments in the migration capacities of the ECFCs were also observed in patients with GPA and controls (12th h, p = 0.05). Incubation of ECFCs from patients with GPA in remission with plasma from healthy controls significantly decreased migration capacity (p = 0.0001). Longitudinal analysis revealed that treatment significantly lowered ECFC migration rates. This study revealed that ECFCs from the patients with PR3‐positive GPA in remission demonstrated early losses of tube formation and reduced migration capacity compared to those of the healthy controls, suggesting impairment of endothelial function.
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Affiliation(s)
- Ana Paula Toledo Del Rio
- Rheumatology Discipline, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Jéssica O Frade-Guanaes
- Hemocentro UNICAMP, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Stephanie Ospina-Prieto
- Hemocentro UNICAMP, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Bruno K L Duarte
- Hemocentro UNICAMP, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Manoel Barros Bertolo
- Rheumatology Discipline, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Margareth C Ozelo
- Hemocentro UNICAMP, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Zoraida Sachetto
- Rheumatology Discipline, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Qiu Y, Zhang Y, Li Y, Hua Y, Zhang Y. Molecular mechanisms of endothelial dysfunction in Kawasaki-disease-associated vasculitis. Front Cardiovasc Med 2022; 9:981010. [PMID: 36003919 PMCID: PMC9393387 DOI: 10.3389/fcvm.2022.981010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/21/2022] [Indexed: 01/14/2023] Open
Abstract
Kawasaki disease (KD) is an acute, inflammation mediated vasculitis, mainly affecting in children under five, which is consider as the most common coronary artery disease in children. The injuries of coronary arteries would result in dilation or thrombus formation, bringing great threaten to patients. Endothelium, located in the inner surface of coronary artery, serves as the interface between the circulating inflammatory cells and vascular media or adventitia, which is the first target of inflammatory attacks during early stage of KD. A series of studies have determined vascular endothelial cells damages and dysfunction in KD patients. However, current therapeutic strategy is still challenging. So that it is critical to underline the mechanisms of endothelium injuries. In this review, the role of endothelial cells in the pathogenesis of KD and the therapeutic methods for endothelial cells were systematically described.
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Pulito-Cueto V, Remuzgo-Martínez S, Genre F, Atienza-Mateo B, Mora-Cuesta VM, Iturbe-Fernández D, Lera-Gómez L, Pérez-Fernández R, Prieto-Peña D, Portilla V, Blanco R, Corrales A, Gualillo O, Cifrián JM, López-Mejías R, González-Gay MA. Endothelial Progenitor Cells: Relevant Players in the Vasculopathy and Lung Fibrosis Associated with the Presence of Interstitial Lung Disease in Systemic Sclerosis Patients. Biomedicines 2021; 9:biomedicines9070847. [PMID: 34356910 PMCID: PMC8301775 DOI: 10.3390/biomedicines9070847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022] Open
Abstract
Endothelial progenitor cells (EPC), which are key effectors in the physiologic vascular network, have been described as relevant players in autoimmune diseases. We previously showed that EPC frequency may help to identify the presence of interstitial lung disease (ILD) in rheumatoid arthritis patients. Given that ILD constitutes the main cause of mortality in systemic sclerosis (SSc) patients, we aimed to determine the EPC contribution to the pathogenic processes of vasculopathy and lung fibrosis in SSc-ILD+. EPC quantification was performed by flow cytometry on blood from 83 individuals: 21 SSc-ILD+ patients and subjects from comparative groups (20 SSc-ILD− and 21 idiopathic pulmonary fibrosis (IPF) patients and 21 healthy controls (HC)). EPC were considered as CD34+, CD45low, CD309+, and CD133+. A significant increase in EPC frequency was found in SSc-ILD+ patients when compared to HC (p < 0.001). SSc-ILD+ patients exhibited a higher EPC frequency than SSc-ILD− patients (p = 0.012), whereas it was markedly reduced compared to IPF patients (p < 0.001). EPC frequency was higher in males (p = 0.04) and negatively correlated to SSc duration (p = 0.04) in SSc-ILD+ patients. Our results indicate a role of EPC in the processes of vasculopathy and lung fibrosis in SSc-ILD+. EPC frequency may be considered as a biomarker of ILD in SSc patients.
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Affiliation(s)
- Verónica Pulito-Cueto
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
| | - Sara Remuzgo-Martínez
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
| | - Fernanda Genre
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
| | - Belén Atienza-Mateo
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- López Albo’ Post-Residency Programme, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Víctor M. Mora-Cuesta
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Pneumology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - David Iturbe-Fernández
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Pneumology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Leticia Lera-Gómez
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
| | - Raquel Pérez-Fernández
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
| | - Diana Prieto-Peña
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Virginia Portilla
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Ricardo Blanco
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Alfonso Corrales
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Oreste Gualillo
- Servizo Galego de Saude and Instituto de Investigación Sanitaria, Hospital Clinico Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - José M. Cifrián
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Pneumology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
- School of Medicine, Universidad de Cantabria, 39011 Santander, Spain
| | - Raquel López-Mejías
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Correspondence: (R.L.-M.); (M.A.G.-G.); Tel.: +34-942-315-515 (R.L.-M. & M.A.G.-G.); Fax: +34-942-31-55-17 (R.L.-M. & M.A.G.-G.)
| | - Miguel A. González-Gay
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, 39011 Santander, Spain; (V.P.-C.); (S.R.-M.); (F.G.); (B.A.-M.); (V.M.M.-C.); (D.I.-F.); (L.L.-G.); (R.P.-F.); (D.P.-P.); (V.P.); (R.B.); (A.C.); (J.M.C.)
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
- School of Medicine, Universidad de Cantabria, 39011 Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa
- Correspondence: (R.L.-M.); (M.A.G.-G.); Tel.: +34-942-315-515 (R.L.-M. & M.A.G.-G.); Fax: +34-942-31-55-17 (R.L.-M. & M.A.G.-G.)
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Ota Y, Kuwana M. Endothelial cells and endothelial progenitor cells in the pathogenesis of systemic sclerosis. Eur J Rheumatol 2019; 7:S139-S146. [PMID: 31922471 DOI: 10.5152/eurjrheum.2019.19158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/25/2019] [Indexed: 12/27/2022] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterized by excessive fibrosis, microvasculopathy, and autoimmunity. Endothelial cell (EC) injury and subsequent endothelial cell dysfunction is believed to be an initial event that eventually leads to a vicious pathogenic cycle. This process is further enhanced by defective angiogenesis and vasculogenesis, as the vascular repair machinery does not work properly. Endothelial progenitor cells (EPCs) are functionally and quantitatively insufficient to recover the endothelium in SSc patients. The dysfunctional ECs and EPCs not only trigger the formation of typical vascular lesions, such as progressive intimal fibrosis in small arteries and the loss of capillaries, but also promote a series of inflammatory and profibrotic processes, such as endothelial-mesenchymal transition and recruitment and accumulation of monocytic EPCs with profibrotic properties. These processes together contribute to the accumulation of extracellular matrix in the affected tissue. This review features current insights into the roles of ECs and EPCs in the pathogenesis of SSc.
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Affiliation(s)
- Yuko Ota
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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Mandraffino G, Aragona CO, Basile G, Cairo V, Mamone F, Morace C, D'Ascola A, Alibrandi A, Lo Gullo A, Loddo S, Saitta A, Imbalzano E. CD34+ cell count predicts long lasting life in the oldest old. Mech Ageing Dev 2017; 164:139-145. [PMID: 28322848 DOI: 10.1016/j.mad.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 12/11/2016] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
Abstract
Circulating progenitor cells (CPCs) represent a pool of cells capable of differentiating into mature cells of different organs and systems, promoting tissue maintenance and repair. Among CPCs, CD34+cells (CD34+CPCs) seem to predict outcome in CV disease, also in elderly people. A decline in CD34+CPCs was reported with advancing age. Moreover, aging is associated with a state of chronic inflammation, influencing life expectancy. Our purpose was to investigate a 10-year predictive ability of CD34+CPCs, inflammatory marker levels, classic CV risk factors (CVRFs), and Framingham Risk Score (FRS) in a population of healthy, self-sufficient octogenarians. We found that baseline CD34+CPCs was strongly associated with mortality, showing a significant difference in CD34+CPC numbers between deceased and living patients. Moreover, by dividing our patients into tertiles based on age reached, this difference was more remarkable the higher the age reached. Regressive analyses suggested that the chances of reaching an older age depend on higher CD34+CPCs at baseline and are not significantly affected by inflammatory markers levels, FRS, CVFRs, or HDL-C levels. We found that higher CD34+CPCs predict longer life also in the oldest old, providing additional insights on the predictive role of CD34+CPCs in subjects aged 80 years or more.
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Affiliation(s)
| | | | - Giorgio Basile
- Department of Clinical and Experimental Medicine, Geriatrics and Gerontology, Italy
| | - Valentina Cairo
- Department of Clinical and Experimental Medicine, Internal Medicine, Italy
| | - Federica Mamone
- Department of Clinical and Experimental Medicine, Internal Medicine, Italy
| | - Carmela Morace
- Department of Clinical and Experimental Medicine, Internal Medicine, Italy
| | - Angela D'Ascola
- Department of Biochemical, Physiological and Nutritional Sciences, Italy
| | - Angela Alibrandi
- Department of Economics, Section of Statistical and Mathematical Sciences, Italy
| | - Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, Internal Medicine, Italy
| | - Saverio Loddo
- Department of Biochemical, Physiological and Nutritional Sciences, Italy
| | - Antonino Saitta
- Department of Clinical and Experimental Medicine, Internal Medicine, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, Internal Medicine, Italy
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