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Rahimi A, Rasouli M, Heidari Keshel S, Ebrahimi M, Pakdel F. Is obesity-induced ECM remodeling a prelude to the development of various diseases? Obes Res Clin Pract 2023; 17:95-101. [PMID: 36863919 DOI: 10.1016/j.orcp.2023.02.002] [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] [Received: 04/24/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Abstract
Due to the increasing incidence rate of obesity worldwide and the associated complications such as type 2 diabetes and cardiovascular diseases, research on the adipose tissue physiology and the role of the extracellular matrix (ECM) has gained tremendous attention. The ECM, one of the most crucial components in body tissues, undergoes remodeling and regeneration of its constituents to guarantee normal tissue function. There is a crosstalk between fat tissue and various body organs, including but not limited to the liver, heart, kidney, skeletal muscle, and so forth. These organs respond to fat tissue signals through changes in ECM, function, and their secretory products. Obesity can cause ECM remodeling, inflammation, fibrosis, insulin resistance, and disrupted metabolism in different organs. However, the mechanisms underlying the reciprocal communication between various organs during obesity are still not fully elucidated. Gaining a profound knowledge of ECM alterations during the progression of obesity will pave the way toward developing potential strategies to either circumvent pathological conditions or open an avenue to treat complications associated with obesity.
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Affiliation(s)
- Azam Rahimi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Rasouli
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Heidari Keshel
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Ebrahimi
- Department of Ophthalmic Plastic & Reconstructive Surgery, Farabi Eye Hospital, Tehran, Iran
| | - Farzad Pakdel
- Ophthalmology Department, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Than WH, Chan GCK, Ng JKC, Szeto CC. The role of obesity on chronic kidney disease development, progression, and cardiovascular complications. ADVANCES IN BIOMARKER SCIENCES AND TECHNOLOGY 2020. [DOI: 10.1016/j.abst.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Abstract
Chronic kidney diseases (CKD), a common outcome of various kidney diseases, cause a series of refractory complications, which lead to great economic burdens on patients. The clinical outcomes of CKD depend on various factors, including metabolic disorders. Leptin, a peptide hormone, produced in adipose tissues, plays an important role in regulating food consumption and energy expenditure. Leptin also influences the immune system and hematopoiesis. Increased leptin status is observed in CKD, leptin deficiency attenuates the immune response in nephritis. Conversely, leptin inhibits the development of obesity, which is closely associated glomerular disorder. Now, the precise role of leptin in CKD remains elusive. This review will give an integrated understanding of the potential role of leptin and its interactions with other signal molecules in CKD.
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Affiliation(s)
- Song Mao
- a Department of Pediatrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Li Fang
- a Department of Pediatrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Fen Liu
- a Department of Pediatrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Siqiong Jiang
- a Department of Pediatrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Liangxia Wu
- a Department of Pediatrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Jianhua Zhang
- b Department of Pediatrics, Xinhua Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
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Manna P, Jain SK. Obesity, Oxidative Stress, Adipose Tissue Dysfunction, and the Associated Health Risks: Causes and Therapeutic Strategies. Metab Syndr Relat Disord 2016; 13:423-44. [PMID: 26569333 DOI: 10.1089/met.2015.0095] [Citation(s) in RCA: 600] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Obesity is gaining acceptance as a serious primary health burden that impairs the quality of life because of its associated complications, including diabetes, cardiovascular diseases, cancer, asthma, sleep disorders, hepatic dysfunction, renal dysfunction, and infertility. It is a complex metabolic disorder with a multifactorial origin. Growing evidence suggests that oxidative stress plays a role as the critical factor linking obesity with its associated complications. Obesity per se can induce systemic oxidative stress through various biochemical mechanisms, such as superoxide generation from NADPH oxidases, oxidative phosphorylation, glyceraldehyde auto-oxidation, protein kinase C activation, and polyol and hexosamine pathways. Other factors that also contribute to oxidative stress in obesity include hyperleptinemia, low antioxidant defense, chronic inflammation, and postprandial reactive oxygen species generation. In addition, recent studies suggest that adipose tissue plays a critical role in regulating the pathophysiological mechanisms of obesity and its related co-morbidities. To establish an adequate platform for the prevention of obesity and its associated health risks, understanding the factors that contribute to the cause of obesity is necessary. The most current list of obesity determinants includes genetic factors, dietary intake, physical activity, environmental and socioeconomic factors, eating disorders, and societal influences. On the basis of the currently identified predominant determinants of obesity, a broad range of strategies have been recommended to reduce the prevalence of obesity, such as regular physical activity, ad libitum food intake limiting to certain micronutrients, increased dietary intake of fruits and vegetables, and meal replacements. This review aims to highlight recent findings regarding the role of oxidative stress in the pathogenesis of obesity and its associated risk factors, the role of dysfunctional adipose tissue in development of these risk factors, and potential strategies to regulate body weight loss/gain for better health benefits.
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Affiliation(s)
- Prasenjit Manna
- Department of Pediatrics, LSU Health Sciences Center , Shreveport, Louisiana
| | - Sushil K Jain
- Department of Pediatrics, LSU Health Sciences Center , Shreveport, Louisiana
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Nagy K, Nagaraju SP, Rhee CM, Mathe Z, Molnar MZ. Adipocytokines in renal transplant recipients. Clin Kidney J 2016; 9:359-73. [PMID: 27274819 PMCID: PMC4886901 DOI: 10.1093/ckj/sfv156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/18/2015] [Indexed: 02/07/2023] Open
Abstract
In the last two decades, perceptions about the role of body fat have changed. Adipocytes modulate endocrine and immune homeostasis by synthesizing hundreds of hormones, known as adipocytokines. Many studies have been investigating the influences and effects of these adipocytokines and suggest that they are modulated by the nutritional and immunologic milieu. Kidney transplant recipients (KTRs) are a unique and relevant population in which the function of adipocytokines can be examined, given their altered nutritional and immune status and subsequent dysregulation of adipocytokine metabolism. In this review, we summarize the recent findings about four specific adipocytokines and their respective roles in KTRs. We decided to evaluate the most widely described adipocytokines, including leptin, adiponectin, visfatin and resistin. Increasing evidence suggests that these adipocytokines may lead to cardiovascular events and metabolic changes in the general population and may also increase mortality and graft loss rate in KTRs. In addition, we present findings on the interrelationship between serum adipocytokine levels and nutritional and immunologic status, and mechanisms by which adipocytokines modulate morbidity and outcomes in KTRs.
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Affiliation(s)
- Kristof Nagy
- Department of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | | | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension , University of California Irvine , Orange, CA , USA
| | - Zoltan Mathe
- Department of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine , University of Tennessee Health Science Center , Memphis, TN , USA
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Briffa JF, McAinch AJ, Poronnik P, Hryciw DH. Adipokines as a link between obesity and chronic kidney disease. Am J Physiol Renal Physiol 2013; 305:F1629-36. [PMID: 24107418 DOI: 10.1152/ajprenal.00263.2013] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Adipocytes secrete a number of bioactive adipokines that activate a variety of cell signaling pathways in central and peripheral tissues. Obesity is associated with the altered production of many adipokines and is linked to a number of pathologies. As an increase in body weight is directly associated with an increased risk for developing chronic kidney disease (CKD), there is significant interest in the link between obesity and renal dysfunction. Altered levels of the adipokines leptin, adiponectin, resistin, and visfatin can decrease the glomerular filtration rate and increase albuminuria, which are pathophysiological changes typical of CKD. Specifically, exposure of the glomerulus to altered adipokine levels can increase its permeability, fuse the podocytes, and cause mesangial cell hypertrophy, all of which alter the glomerular filtration rate. In addition, the adipokines leptin and adiponectin can act on tubular networks. Thus, adipokines can act on multiple cell types in the development of renal pathophysiology. Importantly, most studies have been performed using in vitro models, with future studies in vivo required to further elucidate the specific roles that adipokines play in the development and progression of CKD.
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Affiliation(s)
- Jessica F Briffa
- Dept. of Physiology, The Univ. of Melbourne, Parkville, VIC 3010, Australia.
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Abstract
A close association between the obesity hormone leptin and breast cancer progression has been suggested. The present study investigated the molecular mechanism for enhanced leptin expression in breast cancer cells and its functional significance in breast cancer aggressiveness. We examined whether leptin expression level is affected by the oncoprotein human epidermal growth factor receptor2 (HER2), which is overexpressed in ∼30% of breast tumors. Here, we report, for the first time, that HER2 induces transcriptional activation of leptin in MCF10A human breast epithelial cells. We also showed that p38 mitogen-activated protein kinase signaling was involved in leptin expression induced by HER2. We showed a crucial role of leptin in the invasiveness of HER2-MCF10A cells using an siRNA molecule targeting leptin. Taken together, the results indicate a molecular link between HER2 and leptin, providing supporting evidence that leptin represents a target for breast cancer therapy. [BMB Reports 2012; 45(12): 719-723].
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Affiliation(s)
- Yujin Cha
- College of Pharmacy, Duksung Women's University, Seoul 132-714, Korea
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Wendremaire M, Mourtialon P, Goirand F, Lirussi F, Barrichon M, Hadi T, Garrido C, Le Ray I, Dumas M, Sagot P, Bardou M. Effects of leptin on lipopolysaccharide-induced remodeling in an in vitro model of human myometrial inflammation. Biol Reprod 2013; 88:45. [PMID: 23303680 DOI: 10.1095/biolreprod.112.104844] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Reorganization of myometrial extracellular matrix (ECM) is essential for the uterus to achieve powerful synchronous contractions during labor. Remodeling of the ECM has been implicated in membrane rupture and cervical ripening. Because maternal obesity is associated with both delivery disorders and elevated circulating leptin levels, this study aimed to assess the ability of leptin to interfere with lipopolysaccharide (LPS)-induced myometrial ECM remodeling. Myometrial biopsy samples were obtained from women undergoing cesarean delivery before labor onset. Myometrial explants were incubated for 48 h with LPS and leptin. LPS challenge was associated with a marked decrease in collagen content and in heat shock protein (HSP) 47 expression, reflecting a disruption in collagen synthesis and an increase in matrix metalloproteinase (MMP) 2 and MMP9 activity and in MMP2, MMP9, and MMP13 expression. Leptin prevented an LPS-induced decrease in myometrial collagen content in a concentration-dependent manner. This effect was associated with an increase in HSP47 expression and a decrease in MMP2 and MMP9 activity and expression. These results show that leptin prevents LPS-induced myometrial remodeling through collagen synthesis stimulation and inhibition of MMP2 and MMP9. Our study strengthens the hypothesis that leptin plays a role in the development of obesity-related delivery disorders.
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Affiliation(s)
- Maeva Wendremaire
- Institut National de la Santé Et de la Recherche Médicale (INSERM), U866, Lipides, Nutrition, Cancer, Dijon, France
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Nourshahi M, Hedayati M, Ranjbar K. The correlation between resting serum leptin and serum angiogenic indices at rest and after submaximal exercise. ACTA ACUST UNITED AC 2011; 173:6-12. [PMID: 21924298 DOI: 10.1016/j.regpep.2011.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/08/2011] [Accepted: 08/15/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of leptin as stimulant angiogenic factor has been studied. But the association of leptin levels and exercise-induced angiogenesis has not been studied. Accordingly, the researchers investigated whether there were any differences in circulating serum VEGF, MMP-2 and MMP-9 among high and low resting leptin individuals at rest or in response to submaximal exercise. MATERIALS AND METHODS For this purpose the researchers defined two groups with high and low resting leptin levels. Fifteen subjects with high resting leptin (23.57±9.14ng/ml and Vo(2) max=29.46±3.62ml/kg.min) and fifteen subjects with low resting leptin level (1.04±0.49ng/ml and Vo(2) max=37.99±4.63ml/kgmin) exercised for 1h (1h) at 70% of Vo(2) max. Antecubital vein blood was collected at rest, immediately and 2h post exercise. Serum VEGF, MMP-2 and MMP-9 was measured by ELISA method. RESULTS Results of the study showed that the resting serum levels of VEGF, MMP-2 and MMP-9 didn't have any correlation with basic levels of leptin. In low leptin group the levels of VEGF and MMP-2 in immediately post exercise decreased significantly, but in high leptin group, only VEGF decreased significantly. 2h post exercise; the VEGF level in the low resting leptin group was significantly lower than that of its basal level. Beside, MMP-2 in the high and low basic levels of leptin groups were significantly increased compared to that of immediately post exercise. But the amount of MMP-9 did not change significantly in response to exercise in two groups. There were not any differences in the changes of VEGF, MMP-2 and MMP-9 in response to exercise between two groups. Furthermore, resting leptin had a significant correlation with V0(2) max. CONCLUSION The obtained results showed that the serum VEGF, MMP-2 and MMP-9 did not have any correlation with basic levels of leptin. In addition, it was concluded that levels of different resting leptin is ineffective on serum levels of VEGF, MMP-2 and MMP-9 at rest and in response to exercise in normal healthy subjects.
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Affiliation(s)
- Maryam Nourshahi
- Department of Sport Physiology, Faculty of Physical Education and Sport Sciences, Shahid Beheshti University, G.C., Evin 198396113, Tehran, Iran.
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Van Hul M, Lijnen HR. Matrix metalloproteinase inhibition impairs murine adipose tissue development independently of leptin. Endocr J 2011; 58:101-7. [PMID: 21242647 DOI: 10.1507/endocrj.k10e-267] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Administration of Tolylsam, a MMP inhibitor with relative specificity for gelatinases, at a dose of 100 mg/kg/day to leptin-deficient (ob/ob) mice kept on high fat diet for 15 weeks, was associated with significantly reduced weight gain as compared to controls (p < 0.0005), resulting in lower body weight (p < 0.0005) at the end of the experiments. Food intake, physical activity and body temperature were not affected. Subcutaneous (SC) (2.9 ± 0.1g vs. 3.4 ± 0.2g in controls; p < 0.05) and gonadal (GON) (3.4 ± 0.1g vs. 3.7 ± 0.1g in controls; p = NS) fat mass were reduced by Tolylsam treatment. Reduced MMP-2 (gelatinase A) activity in adipose tissue extracts was confirmed by zymography. Mild adipocyte hypotrophy was observed in treated SC and GON adipose tissues. Blood vessel density was significantly reduced in Tolylsam treated SC (p < 0.05) and GON (p < 0.005) adipose tissues. Sirius red staining revealed comparable collagen content in both SC and GON fat of treated mice, whereas collagen disorganization (ratio thick/thin fibers) was also similar. Thus, gelatinase inhibition in mice with leptin deficiency resulted in lower body and fat pad weights, associated with mild adipocyte hypotrophy. This indicates that MMP inhibition may impair adipose tissue development independently of leptin.
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Affiliation(s)
- Matthias Van Hul
- Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
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Schram K, Sweeney G. Implications of Myocardial Matrix Remodeling by Adipokines in Obesity-Related Heart Failure. Trends Cardiovasc Med 2008; 18:199-205. [DOI: 10.1016/j.tcm.2008.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 10/17/2008] [Accepted: 10/21/2008] [Indexed: 01/23/2023]
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Huang K, Rabold R, Abston E, Schofield B, Misra V, Galdzicka E, Lee H, Biswal S, Mitzner W, Tankersley CG. Effects of leptin deficiency on postnatal lung development in mice. J Appl Physiol (1985) 2008; 105:249-59. [PMID: 18467551 DOI: 10.1152/japplphysiol.00052.2007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Leptin modulates energy metabolism and lung development. We hypothesize that the effects of leptin on postnatal lung development are volume dependent from 2 to 10 wk of age and are independent of hypometabolism associated with leptin deficiency. To test the hypotheses, effects of leptin deficiency on lung maturation were characterized in age groups of C57BL/6J mice with varying Lep(ob) genotypes. Quasi-static pressure-volume curves and respiratory impedance measurements were performed to profile differences in respiratory system mechanics. Morphometric analysis was conducted to estimate alveolar size and number. Oxygen consumption was measured to assess metabolic rate. Lung volume at 40-cmH(2)O airway pressure (V(40)) increased with age in each genotypic group, and V(40) was significantly (P < 0.05) lower in leptin-deficient (ob/ob) mice beginning at 2 wk. Differences were amplified through 7 wk of age relative to wild-type (+/+) mice. Morphometric analysis showed that alveolar surface area was lower in ob/ob compared with +/+ and heterozygote (ob/+) mice beginning at 2 wk. Unlike the other genotypic groups, alveolar size did not increase with age in ob/ob mice. In another experiment, ob/ob at 4 wk received leptin replacement (5 microg.g(-1) x day(-1)) for 8 days, and expression levels of the Col1a1, Col3a1, Col6a3, Mmp2, Tieg1, and Stat1 genes were significantly increased concomitantly with elevated V(40). Leptin-induced increases in V(40) corresponded with enlarged alveolar size and surface area. Gene expression suggested a remodeling event of lung parenchyma after exogenous leptin replacement. These data support the hypothesis that leptin is critical to postnatal lung remodeling, particularly related to increased V(40) and enlarged alveolar surface area.
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Affiliation(s)
- Kewu Huang
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health Sciences, Baltimore, MD 21205, USA
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Nath AK, Brown RM, Michaud M, Sierra-Honigmann MR, Snyder M, Madri JA. Leptin affects endocardial cushion formation by modulating EMT and migration via Akt signaling cascades. ACTA ACUST UNITED AC 2008; 181:367-80. [PMID: 18411306 PMCID: PMC2315681 DOI: 10.1083/jcb.200708197] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Blood circulation is dependent on heart valves to direct blood flow through the heart and great vessels. Valve development relies on epithelial to mesenchymal transition (EMT), a central feature of embryonic development and metastatic cancer. Abnormal EMT and remodeling contribute to the etiology of several congenital heart defects. Leptin and its receptor were detected in the mouse embryonic heart. Using an ex vivo model of cardiac EMT, the inhibition of leptin results in a signal transducer and activator of transcription 3 and Snail/vascular endothelial cadherin-independent decrease in EMT and migration. Our data suggest that an Akt signaling pathway underlies the observed phenotype. Furthermore, loss of leptin phenocopied the functional inhibition of alphavbeta3 integrin receptor and resulted in decreased alphavbeta3 integrin and matrix metalloprotease 2, suggesting that the leptin signaling pathway is involved in adhesion and migration processes. This study adds leptin to the repertoire of factors that mediate EMT and, for the first time, demonstrates a role for the interleukin 6 family in embryonic EMT.
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Affiliation(s)
- Anjali K Nath
- Department of Pathology, School of Medicine, Yale University, New Haven, CT 06510, USA
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Bełtowski J, Wójcicka G, Trzeciak J, Marciniak A. H2O2 and Src-dependent transactivation of the EGF receptor mediates the stimulatory effect of leptin on renal ERK and Na+, K+-ATPase. Peptides 2006; 27:3234-44. [PMID: 16973240 DOI: 10.1016/j.peptides.2006.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 08/10/2006] [Accepted: 08/11/2006] [Indexed: 01/03/2023]
Abstract
We examined the mechanism through which leptin increases Na(+), K(+)-ATPase activity in the rat kidney. Leptin was infused under anaesthesia into the abdominal aorta proximally to the renal arteries and then Na(+), K(+)-ATPase activity was measured in the renal cortex and medulla. Leptin (1mug/kgmin) increased Na(+), K(+)-ATPase activity after 3h of infusion, which was accompanied by the increase in urinary H(2)O(2) excretion and phosphorylation level of extracellular signal regulated kinase (ERK). The effect of leptin on ERK and Na(+), K(+)-ATPase was abolished by catalase, specific inhibitors of epidermal growth factor (EGF) receptor, AG1478 and PD158780, as well as by ERK inhibitor, PD98059, and was mimicked by both exogenous H(2)O(2) and EGF. The effect of leptin was also prevented by the inhibitor of Src tyrosine kinase, PP2. Leptin and H(2)O(2) increased Src phosphorylation at Tyr(418). We conclude that leptin-induced stimulation of renal Na(+), K(+)-ATPase involves H(2)O(2) generation, Src kinase, transactivation of the EGF receptor, and stimulation of ERK.
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Affiliation(s)
- Jerzy Bełtowski
- Department of Pathophysiology, Medical University, ul. Jaczewskiego 8, 20-090 Lublin, Poland.
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