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Han L, Tan H, Lee J, Wang P, Zhao Y. Synthesis of triazole AD-1 derivatives and its mechanism of mediating DNA damage of ROS in lung cancer cells. Bioorg Chem 2024; 148:107457. [PMID: 38763000 DOI: 10.1016/j.bioorg.2024.107457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/03/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
Based on the significant biological activities and the remarkable physical and chemical properties of 1H-1,2,3-triazole pharmacophore, we herein adopted the strategy of click chemistry to combine the triazole fragment and the unique scaffold of 25-OCH3-PPD (AD-1) to design a series of potent compounds inducing apoptosis and DNA damage. The anti-proliferative effect was verified by MTT assay and colony formation assay. DNA double-stand breaks (DSBs) were obtained by observing the nuclear focus formation and the protein expression of γ-H2AX. Cell cycle arrest was evaluated by the cycle-related proteins such as CDK2, CDK4, CDK6, Cyclin D1 and P21. Apoptosis was assessed by flow cytometry, mitochondrial membrane potential (MMP) detection and the expression of apoptosis-related proteins. Reactive oxygen species (ROS) generation was measured with 2', 7'-dichlorofluorescein diacetate (DCFH-DA) staining. According to SAR analysis, the most potent compound 6a exhibited great inhibitory effect against A549 cells, which IC50 value of 2.84 ± 0.68 μM. Furthermore, 6a remarkably induced DNA damage, cell cycle arrest and apoptosis in A549 cells. 6a treatment increased the levels of ROS. Network pharmacology and molecular docking predicted the potential signaling pathways and ligand-receptor interactions, and the results of western blotting showed that 6a inhibited the PI3K/Akt/Bcl-2 signaling pathway by decreasing PI3K and Bcl-2 and total level of Akt expression, while Bax and Cyt c were increasing in 6a-treated A549 cells. As mentioned above, 6a has a potent inhibitory effect in A549 cells through induction of DNA damage, apoptosis via ROS generation and modulation of PI3K/Akt/Bcl-2 signaling pathway.
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Affiliation(s)
- Linlin Han
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin Province, 133002, China
| | - Hongyan Tan
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin Province, 133002, China
| | - Jungjoon Lee
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin Province, 133002, China
| | - Peng Wang
- ORxes Therapeutics (Shanghai)Co., Ltd., Shanghai 200120, China.
| | - Yuqing Zhao
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin Province, 133002, China.
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Wang K, Xu Y, Huang H, Peng D, Chen J, Li P, Du B. Porcupine quills keratin peptides induces G0/G1 cell cycle arrest and apoptosis via p53/p21 pathway and caspase cascade reaction in MCF-7 breast cancer cells. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024; 104:1741-1755. [PMID: 37862230 DOI: 10.1002/jsfa.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Porcupine quills, a by-product of porcupine pork, are rich in keratin, which is an excellent source of bioactive peptides. The objective of this study was to investigate the underlying mechanism of anti-proliferation effect of porcupine quills keratin peptides (PQKPs) on MCF-7 cells. RESULTS Results showed that PQKPs induced MCF-7 cells apoptosis by significantly decreasing the secretion level of anti-apoptosis protein Bcl-2 and increasing the secretion levels of pro-apoptosis proteins Bax, cytochrome c, caspase 9, caspase 3 and PARP. PQKPs also arrested the cell cycle at G0/G1 phase via remarkably reducing the protein levels of CDK4 and enhancing the protein levels of p53 and p21. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) analysis identified nine peptides with molecular weights less than 1000 Da in PQKPs. Molecular docking results showed that TPGPPT and KGPAC identified from PQKPs could bind with p53 mutant and Bcl-2 protein by conventional hydrogen bonds, carbon hydrogen bonds and van der Waals force. Furthermore, the anti-proliferation impact of synthesized peptides (TPGPPT and KGPAC) was shown in MCF-7 cells. CONCLUSION These findings indicated that PQKPs suppressed the proliferation of MCF-7 breast cancer cells by triggering apoptosis and G0/G1 cell cycle arrest. Moreover, the outcome of this study will bring fresh insights into the production and application of animal byproducts. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Kun Wang
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Yanan Xu
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Haozhang Huang
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Dong Peng
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Jianping Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Pan Li
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Bing Du
- College of Food Science, South China Agricultural University, Guangzhou, China
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Lin L, Zhao Y, Wang P, Li T, Liang Y, Chen Y, Meng X, Zhang Y, Su G. Amino Acid Derivatives of Ginsenoside AD-2 Induce HepG2 Cell Apoptosis by Affecting the Cytoskeleton. Molecules 2023; 28:7400. [PMID: 37959819 PMCID: PMC10650444 DOI: 10.3390/molecules28217400] [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: 09/11/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
AD-2 (20(R)-dammarane-3β, 12β, 20, 25-tetrol, 25-OH-PPD) was structurally modified to introduce additional amino groups, which can better exert its anti-tumor effects in MCF-7, A549, LoVo, HCT-116, HT -29, and U-87 cell lines. We investigated the cellular activity of 15 different AD-2 amino acid derivatives on HepG2 cells and the possible mechanism of action of the superior derivative 6b. An MTT assay was used to detect the cytotoxicity of the derivatives. Western blotting was used to study the signaling pathways. Flow cytometry was used to detect cell apoptosis and ghost pen peptide staining was used to identify the changes in the cytoskeleton. The AD-2 amino acid derivatives have a better cytotoxic effect on the HepG2 cells than AD-2, which may be achieved by promoting the apoptosis of HepG2 cells and influencing the cytoskeleton. The derivative 6b shows obvious anti-HepG2 cells activity through affecting the expression of apoptotic proteins such as MDM2, P-p53, Bcl-2, Bax, Caspase 3, Cleaved Caspase 3, Caspase 8, and NSD2. According to the above findings, the amino acid derivatives of AD-2 may be developed as HepG2 cytotoxic therapeutic drugs.
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Affiliation(s)
- Lizhen Lin
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China; (L.L.); (Y.L.); (Y.C.); (X.M.); (Y.Z.)
| | - Yuqing Zhao
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Yanbian University, Yanji 133002, China;
| | - Peng Wang
- ORxes Therapeutics (Shanghai) Co., Ltd., Shanghai 200000, China;
| | - Tao Li
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Yanbian University, Yanji 133002, China;
| | - Yuhang Liang
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China; (L.L.); (Y.L.); (Y.C.); (X.M.); (Y.Z.)
| | - Yu Chen
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China; (L.L.); (Y.L.); (Y.C.); (X.M.); (Y.Z.)
| | - Xianyi Meng
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China; (L.L.); (Y.L.); (Y.C.); (X.M.); (Y.Z.)
| | - Yudong Zhang
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China; (L.L.); (Y.L.); (Y.C.); (X.M.); (Y.Z.)
| | - Guangyue Su
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China; (L.L.); (Y.L.); (Y.C.); (X.M.); (Y.Z.)
- Key Laboratory of Innovative Traditional Chinese Medicine for Major Chronic Diseases of Liaoning Province, Shenyang 110016, China
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Chen Y, Lin L, Yang C, Li T, Li Y, Wang J, Wu Y, Zhao Y, Su G. Ginsenoside AD-2 Ameliorating Lipopolysaccharide-Induced Activation in HSC-T6 Cells and Carbon Tetrachloride-Induced Hepatic Fibrosis in Mice via Regulation of VD-VDR Axis. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:3459-3471. [PMID: 36644954 DOI: 10.1021/acs.jafc.2c06804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Ginsenoside 25-hydroxy protopanaxadiol (AD-2) isolated from ginseng was proved to have anti-hepatic fibrosis (HF) effect in our previous study. But the mechanism is unknown. The present study investigated the anti-HF effects and mechanisms of AD-2 on the lipopolysaccharide (LPS)-induced activation in HSC-T6 cells and carbon tetrachloride (CCl4)-induced hepatic fibrosis (HF) in mice. Results showed that AD-2 significantly inhibited the LPS-induced activated HSC-T6 cells in vitro and markedly reduced the serum transaminase and hydroxyproline levels, pathological changes, and hepatic body ratio in CCl4-induced HF mice, indicating AD-2 ameliorated liver injury and reversed HF notably. Moreover, AD-2 decreased the expression of TGF-β1, α-SMA, and MMP2, and maintained TIMP1/MMP9 in balance with the level of vitamin D (VD) and the expression of VD nuclear receptor (VDR) and Sirt3 increased. In conclusion, the anti-HF mechanism of AD-2 is related to the inhibition of HSC activation, promotion of collagen degradation, and regulation of the VD/VDR axis.
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Affiliation(s)
- Yu Chen
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Lizhen Lin
- Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Chunhong Yang
- College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Tao Li
- College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Yuan Li
- Shenyang Pharmaceutical University, Shenyang 110016, China
- Basic Medical Teaching and Research Department, Liaoning Vocational College of Medicine, Shenyang 110101, China
| | - Jian Wang
- Shenyang Pharmaceutical University, Shenyang 110016, China
- Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, China
| | - Yanling Wu
- College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Yuqing Zhao
- College of Pharmacy, Yanbian University, Yanji 133002, China
| | - Guangyue Su
- Shenyang Pharmaceutical University, Shenyang 110016, China
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Han L, Liu J, Yang Y, Zhang H, Gao L, Li Y, Chang S, Sun X. Pseudo-sapogenin DQ 3-mimaleate acid derivative induces ovarian carcinoma cell apoptosis via mitochondrial pathway. Chem Pharm Bull (Tokyo) 2022; 70:427-434. [PMID: 35418544 DOI: 10.1248/cpb.c21-01089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the present study, four novel ginsenosides fatty acid and aromatic acid derivatives were designed and synthesized, and their cytotoxic effects on human ovarian carcinoma cells (SKOV3) were assessed using the MTT assay. The results demonstrated that all derivatives inhibited SKOV3 cell growth, and Compound 3 showed the most outstanding anti-proliferative effect on SKOV3 cells. The IC50 value of Compound 3 was 33.8 ± 2.21 μM, less than half of that of cis-platinum (70.1 ± 7.64 μM). Subsequent analysis revealed that Compound 3 could promote SKOV3 cell apoptosis, and the percentage of apoptotic cell population increased with increasing Compound 3 concentrations. In addition, the expression ratios of Bax/Bcl-2, cleaved-Caspase-3/Caspase-3 and cleaved-Caspase-9/Caspase-9 were gradually elevated in Compound 3-treated SKOV3 cells compared with control cells. Furthermore, translocation of Bax to mitochondria was associated with the release of Cytochrome C. Molecular docking analysis revealed three hydrogen-bonds existed in Compound 3 with PARP receptor (PDB code: 5DSY), which may be the target of the anti-ovarian cancer effect of Compound 3. Altogether, our study indicates that Compound 3 induces SKOV3 cell apoptosis via ROS-dependent mitochondrial pathway, and can serve as an anti-cancer agent for treating ovarian carcinoma.
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Affiliation(s)
- Liu Han
- College of pharmacy, Jilin Medical University
| | - Jiahuan Liu
- College of pharmacy, Jilin Medical University
| | - Yuxin Yang
- College of pharmacy, Jilin Medical University
| | | | | | - Yawei Li
- College of pharmacy, Jilin Medical University
| | - Sheng Chang
- College of pharmacy, Jilin Medical University
| | - Xin Sun
- College of pharmacy, Jilin Medical University
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Zhang Y, Yu H, Fu S, Tan L, Liu J, Zhou B, Li L, Liu Y, Wang C, Li P, Liu J. Synthesis and Anti-Hepatocarcinoma Effect of Amino Acid Derivatives of Pyxinol and Ocotillol. Molecules 2021; 26:molecules26040780. [PMID: 33546225 PMCID: PMC7913291 DOI: 10.3390/molecules26040780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/17/2022] Open
Abstract
Aiming at seeking an effective anti-hepatocarcinoma drug with low toxicity, a total of 24 amino acid derivatives (20 new along with 4 known derivatives) of two active ocotillol-type sapogenins (pyxinol and ocotillol) were synthesized. Both in vitro and in vivo anti-hepatocarcinoma effects of derivatives were evaluated. At first, the HepG2 human cancer cell was employed to evaluate the anti-cancer activity. Most of the derivatives showed obvious enhanced activity compared with pyxinol or ocotillol. Among them, compound 2e displayed the most excellent activity with an IC50 value of 11.26 ± 0.43 µM. Next, H22 hepatoma-bearing mice were used to further evaluate the anti-liver cancer activity of compound 2e. It was revealed that the growth of H22 transplanted tumor was significantly inhibited when treated with compound 2e or compound 2e combined with cyclophosphamide (CTX) (p < 0.05, p < 0.01), and the inhibition rates of tumor growth were 35.32% and 55.30%, respectively. More importantly, compound 2e caused limited damage to liver and kidney in contrast with CTX causing significant toxicity. Finally, the latent mechanism of compound 2e was explored by serum and liver metabolomics based on ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) technology. A total of 21 potential metabolites involved in 8 pathways were identified. These results suggest that compound 2e is a promising agent for anti-hepato-carcinoma, and that it also could be used in combination with CTX to increase efficiency and to reduce toxicity.
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Affiliation(s)
- Ying Zhang
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
- The First Hospital of Jilin University, Changchun 130021, China
| | - Hui Yu
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Shuzheng Fu
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Luying Tan
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Junli Liu
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Baisong Zhou
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Le Li
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Yunhe Liu
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Caixia Wang
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Pingya Li
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
| | - Jinping Liu
- School of Pharmaceutical Sciences, Jilin University, Fujin Road 1266, Changchun 130021, China; (Y.Z.); (H.Y.); (S.F.); (L.T.); (J.L.); (B.Z.); (L.L.); (Y.L.); (C.W.); (P.L.)
- Research Center of Natural Drug, Jilin University, Changchun 130021, China
- Correspondence:
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4'- O-methylpyridoxine: Preparation from Ginkgo biloba Seeds and Cytotoxicity in GES-1 Cells. Toxins (Basel) 2021; 13:toxins13020095. [PMID: 33530619 PMCID: PMC7912177 DOI: 10.3390/toxins13020095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 12/30/2022] Open
Abstract
Ginkgo biloba seeds are wildly used in the food and medicine industry. It has been found that 4′-O-methylpyridoxine (MPN) is responsible for the poisoning caused by G. biloba seeds. The objective of this study was to explore and optimize the extraction method of MPN from G. biloba seeds, and investigate its toxic effect on human gastric epithelial cells (GES-1) and the potential related mechanisms. The results showed that the extraction amount of MPN was 1.933 μg/mg, when extracted at 40 °C for 100 min, with the solid–liquid ratio at 1:10. MPN inhibited the proliferation of GES-1 cells, for which the inhibition rate was 38.27% when the concentration of MPN was 100 μM, and the IC50 value was 127.80 μM; meanwhile, the cell cycle was arrested in G2 phase. High concentration of MPN (100 μM) had significant effects on the nucleus of GES-1 cells, and the proportion of apoptotic cells reached 43.80%. Furthermore, the Western blotting analysis showed that MPN could reduce mitochondrial membrane potential by increasing the expression levels of apoptotic proteins Caspase 8 and Bax in GES-1 cells. In conclusion, MPN may induce apoptosis in GES-1 cells, which leads to toxicity in the human body.
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Kuo CY, Chiu V, Hsieh PC, Huang CY, Huang SJ, Tzeng IS, Tsai FM, Chen ML, Liu CT, Chen YR. Chrysophanol attenuates hepatitis B virus X protein-induced hepatic stellate cell fibrosis by regulating endoplasmic reticulum stress and ferroptosis. J Pharmacol Sci 2020; 144:172-182. [PMID: 32811746 DOI: 10.1016/j.jphs.2020.07.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/17/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatitis B virus X protein (HBx) and hepatic stellate cells (HSCs) are critical for liver fibrosis development. Anti-fibrosis occurs via reversion to quiescent-type HSCs or clearance of HSCs via apoptosis or ferroptosis. We aimed to elucidate the role of chrysophanol in rat HSC-T6 cells expressing HBx and investigate whether chrysophanol (isolated from Rheum palmatum rhizomes) influences cell death via ferroptosis in vitro. Analysis of lipid reactive oxygen species (ROS), Bip, CHOP, p-IRE1α, GPX4, SLC7A11, α-SMA, and CTGF showed that chrysophanol attenuated HBx-repressed cell death. Chrysophanol can impair HBx-induced activation of HSCs via endoplasmic reticulum stress (ER stress) and ferroptosis-dependent and GPX4-independent pathways.
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Affiliation(s)
- Chan-Yen Kuo
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Valeria Chiu
- Division of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Po-Chun Hsieh
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Chun-Yen Huang
- Department of Obstetrics and Gynecology, E-Da Hospital, Kaohsiung, Taiwan; Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan.
| | - S Joseph Huang
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, University of South Florida, USA.
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Fu-Ming Tsai
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Mao-Liang Chen
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Chien-Ting Liu
- Division of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Yi-Ru Chen
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
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