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Dettwiler M, Flynn AC, Rigutto-Farebrother J. Effects of Non-Essential "Toxic" Trace Elements on Pregnancy Outcomes: A Narrative Overview of Recent Literature Syntheses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5536. [PMID: 37107818 PMCID: PMC10139051 DOI: 10.3390/ijerph20085536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/06/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Adverse pregnancy outcomes and their complications cause increased maternal and neonatal morbidity and mortality and contribute considerably to the global burden of disease. In the last two decades, numerous narrative and systematic reviews have emerged assessing non-essential, potentially harmful, trace element exposure as a potential risk factor. This narrative review summarizes the recent literature covering associations between exposure to cadmium, lead, arsenic, and mercury and pregnancy outcomes and highlights common limitations of existing evidence that may hinder decision-making within public health. Several initial scoping searches informed our review, and we searched PubMed (latest date July 2022) for the literature published within the last five years reporting on cadmium, lead, arsenic, or mercury and pre-eclampsia, preterm birth, or prenatal growth. Pre-eclampsia may be associated with cadmium and strongly associated with lead exposure, and exposure to these metals may increase risk of preterm birth. Many reviews have observed cadmium to be negatively associated with birth weight. Additionally, lead and arsenic exposure may be negatively associated with birth weight, with arsenic exposure also adversely affecting birth length and head circumference. These findings should be interpreted with caution due to the limitations of the reviews summarized in this paper, including high heterogeneity due to different exposure assessment methods, study designs, and timing of sampling. Other common limitations were the low quality of the included studies, differences in confounding variables, the low number of studies, and small sample sizes.
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Affiliation(s)
- Maria Dettwiler
- Human Nutrition Laboratory, Institute for Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
| | - Angela C. Flynn
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
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Satarug S, Vesey DA, Gobe GC, Phelps KR. Estimation of health risks associated with dietary cadmium exposure. Arch Toxicol 2023; 97:329-358. [PMID: 36592197 DOI: 10.1007/s00204-022-03432-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/13/2022] [Indexed: 01/03/2023]
Abstract
In much of the world, currently employed upper limits of tolerable intake and acceptable excretion of cadmium (Cd) (ECd/Ecr) are 0.83 µg/kg body weight/day and 5.24 µg/g creatinine, respectively. These figures were derived from a risk assessment model that interpreted β2-microglobulin (β2MG) excretion > 300 μg/g creatinine as a "critical" endpoint. However, current evidence suggests that Cd accumulation reduces glomerular filtration rate at values of ECd/Ecr much lower than 5.24 µg/g creatinine. Low ECd/Ecr has also been associated with increased risks of kidney disease, type 2 diabetes, osteoporosis, cancer, and other disorders. These associations have cast considerable doubt on conventional guidelines. The goals of this paper are to evaluate whether these guidelines are low enough to minimize associated health risks reliably, and indeed whether permissible intake of a cumulative toxin like Cd is a valid concept. We highlight sources and levels of Cd in the human diet and review absorption, distribution, kidney accumulation, and excretion of the metal. We present evidence for the following propositions: excreted Cd emanates from injured tubular epithelial cells of the kidney; Cd excretion is a manifestation of current tissue injury; reduction of present and future exposure to environmental Cd cannot mitigate injury in progress; and Cd excretion is optimally expressed as a function of creatinine clearance rather than creatinine excretion. We comprehensively review the adverse health effects of Cd and urine and blood Cd levels at which adverse effects have been observed. The cumulative nature of Cd toxicity and the susceptibility of multiple organs to toxicity at low body burdens raise serious doubt that guidelines concerning permissible intake of Cd can be meaningful.
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Affiliation(s)
- Soisungwan Satarug
- Kidney Disease Research Collaborative, Level 5, Translational Research Institute, Brisbane, QLD, Australia.
| | - David A Vesey
- Kidney Disease Research Collaborative, Level 5, Translational Research Institute, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Glenda C Gobe
- Kidney Disease Research Collaborative, Level 5, Translational Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence for CKD QLD, UQ Health Sciences, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Kenneth R Phelps
- Stratton Veterans Affairs Medical Center and Albany Medical College, Albany, NY, USA
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Phillippe M. Telomeres, oxidative stress, and timing for spontaneous term and preterm labor. Am J Obstet Gynecol 2022; 227:148-162. [PMID: 35460626 DOI: 10.1016/j.ajog.2022.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
Telomeres are nucleoprotein complexes located at the distal ends of chromosomes. In adults, progressive telomere shortening occurs throughout the lifetime and is thought to contribute to progressive aging, physiological senescence, multiorgan dysfunction, and ultimately, death. As discussed in this review, multiple lines of evidence provide support for the biological plausibility that a telomere-based clock mechanism also determines the length of gestation, leading to the onset of labor (parturition). After telomere expansion at the beginning of pregnancy, the telomere lengths in the gestational tissues (ie, the placenta and fetal membranes) progressively shorten throughout the remainder of pregnancy. The rate of telomere shortening can be accelerated by conditions that affect the mother and result in oxidative stress. Preterm births in the United States are associated with multiple risk factors that are linked with increased oxidative stress. Antioxidant vitamins (ie, vitamins E and C) mitigate the effects of oxidative stress and delay or prevent telomere shortening. Clinical trials with vitamins E and C and with multivitamins started during the periconception period have been associated with reduced rates of preterm births. In the United States, African-American women have a 2-3-fold higher rate of preterm birth. African-American women have multiple risk factors for premature birth, all of which are distinct and potentially additive with regard to epigenetic telomere shortening. The "weathering effect" is the hypothesis to explain the increased rates of chronic illness, disabilities, and early death observed in African-Americans. With regard to pregnancy, accelerated weathering with the associated telomere shortening in the gestational tissues would not only explain the preterm birth disparity but could also explain why highly educated, affluent African-American women continue to have an increased rate of preterm birth. These studies suggest that the racial disparities in preterm birth are potentially mediated by telomere shortening produced by lifetime or even generational exposure to the effects of systemic racism and socioeconomic marginalization. In conclusion, this review presents multiple lines of evidence supporting a novel hypothesis regarding the biological clock mechanism that determines the length of pregnancy, and it opens the possibility of new approaches to prevent or reduce the rate of spontaneous preterm birth.
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Neamtu RI, Craina M, Dahma G, Popescu AV, Erimescu AG, Citu I, Dobrescu A, Horhat FG, Vulcanescu DD, Gorun F, Bernad ES, Motoc A, Citu IC. Heavy metal ion concentration in the amniotic fluid of preterm and term pregnancies from two cities with different industrial output. Exp Ther Med 2022; 23:111. [PMID: 34970334 PMCID: PMC8713173 DOI: 10.3892/etm.2021.11034] [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: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Abstract
The growth and development of the fetus is a complex phenomenon that can be influenced by several variables. High quantities of heavy metal ions in the amniotic fluid have been linked to poor health, especially in industrial, polluted and poor areas. The aim of the present study was to assess the differences in the concentration of these ions between preterm (weeks 15-37) and term pregnancies (starting at week 37). Another objective was to compare pregnancies from two cities with different industry levels. Two sample lots from two Romanian cities were analyzed. A total of 100 patients from Timisoara were compared with 60 from Petrosani, a heavy industry city in Romania. Demographic data were collected, and amniocentesis was performed on all women. Lead (Pb), copper (Cu), nickel (Ni), cadmium (Cd), arsenic (As), iron (Fe) and zinc (Zn) concentrations were assessed. Descriptive and analytical statistics were performed using the Mann-Whitney U test for non-parametric data and the Fisher's exact test for categorical data. In addition, categorical data was represented graphically. In the Timisoara cohort, the differences in heavy metal concentrations between preterm and term pregnancies were not statistically significant. In the Petrosani cohort, however, the concentrations of Zn (P=0.02606) and Cd (P=0.01512) were higher in preterm than in term pregnancies. When comparing the two cohorts as a whole, the concentration of Pb (P=0.04513), Cd (P=0.00002), As (P=0.03027) and Zn (P<0.00001) were higher in the patients from Petrosani than in those from Timisoara. Only Cu concentrations were higher in the Timisoara cohort (P<0.00001). The concentrations of Ni (P=0.78150) and Fe (P=0.44540) did not differ statistically. Thus, amniocentesis is an important diagnostic and exploratory tool in determining differences in the concentrations of elements such as heavy metal ions. Research over a longer period of time should be carried out to examine the relation between heavy metal ions concentration and possible postnatal health outcomes.
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Affiliation(s)
- Radu Ionut Neamtu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - George Dahma
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alin Viorel Popescu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adelina Geanina Erimescu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Citu
- Department of Internal Medicine I, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Amadeus Dobrescu
- Department of Surgery, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Florin George Horhat
- Multidisciplinary Research Center on Antimicrobial Resistance (Multi-Rez), Microbiology Department, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Clinical Laboratory, 'Louis Turcanu' Emergency Hospital for Children, 300011 Timisoara, Romania
| | - Dan Dumitru Vulcanescu
- Multidisciplinary Research Center on Antimicrobial Resistance (Multi-Rez), Microbiology Department, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Clinical Laboratory, 'Louis Turcanu' Emergency Hospital for Children, 300011 Timisoara, Romania
| | - Florin Gorun
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Elena Silvia Bernad
- Department of Internal Medicine I, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andrei Motoc
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Department of Anatomy and Embryology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioan Cosmin Citu
- Department of Obstetrics-Gynecology and Neonatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Rahimi Kakavandi N, Hashemi Moosavi M, Asadi T, Abyadeh M, Yarizadeh H, Sezavar AH, Abdollahi M. Association of maternal intake of nitrate and risk of birth defects and preterm birth: a systematic review and dose-response meta-analysis. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:514-523. [PMID: 34369859 DOI: 10.1080/19338244.2021.1953955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this study, the high versus low analysis method was applied to evaluate the association of maternal nitrate intake and risk of heart defect, limb deficiency, cleft lip, and preterm birth. Also, linear and non-linear dose-response associations between maternal intake of nitrate and risk of heart defects were investigated. In high versus low intake, the risk of heart defects in infants is directly associated with the level of nitrate exposure, but no significant relationship was found between the cleft lip, limb deficiency, and preterm birth. The linear dose-response meta-analysis was associated with risk of heart defects (RR: 1.03; 95% CI: 1.00 to 1.05, P = 0.400, I2= 0%, P heterogeneity= 0.602, n = 3) and nonlinear dose-response meta-analysis showed that maternal intake of nitrate higher than ∼4 mg/day is positively associated with heart defects risk (P non-linearity= 0.012).
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Affiliation(s)
- Nader Rahimi Kakavandi
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Students Scientific Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Motahareh Hashemi Moosavi
- Department of Food Science and Technology, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tayebeh Asadi
- Department of Toxicology and Pharmacology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
- Students Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Morteza Abyadeh
- Department of Molecular Systems Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Habib Yarizadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ahmad Habibian Sezavar
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Habibian A, Abyadeh M, Abyareh M, Rahimi Kakavandi N, Habibian A, Khakpash M, Ghazi-Khansari M. Association of maternal lead exposure with the risk of preterm: a meta-analysis. J Matern Fetal Neonatal Med 2021; 35:7222-7230. [PMID: 34210236 DOI: 10.1080/14767058.2021.1946780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The relationship between maternal lead level and risk of preterm birth (PTB) remained controversial. Therefore, herein we performed this meta-analysis to investigate the association of maternal blood, urine and cord blood lead level with the risk of PTB using observational studies. METHODS A systematic search was conducted in PubMed, EMBASE and Ovid Medline databases from inception to August 2019, and sixteen studies with 65600 participants investigating the association between maternal lead level and PTB were included in our meta-analysis. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated for the highest versus lowest lead level by random-effects model. RESULTS Overall, the pooled OR of all included articles for the highest versus lowest PTB score was 1.29 (95% CI = 1.14-1.46; I2 = 80.4%, p < .001), and the results revealed a direct and significant relationship between second and third trimester blood lead level (BLL) and PTB (OR 2nd trimester= 1.61, 95% CI = 1.08-2.40, OR 3rd trimester= 1.57, 95% CI = 1.11-2.23). CONCLUSION Results of this meta-analysis showed that maternal BLL is directly associated with the risk of PTB.
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Affiliation(s)
- Ahmad Habibian
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Morteza Abyadeh
- Department of Molecular Systems Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mostafa Abyareh
- Department of Environment, Faculty of Natural Resources, Yazd University, Yazd, Iran
| | - Nader Rahimi Kakavandi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Atefeh Habibian
- Department of Midwifery, School of Medicine, Islamic Azad University, Zahedan Branch, Zahedan, Iran
| | - Maliheh Khakpash
- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahmoud Ghazi-Khansari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Sezavar AH, Pourhassan B, Kakavandi NR, Hooshangi Shayeste MR, Abyadeh M. Association of maternal blood lead concentration with the risk of small for gestational age: A dose-response meta-analysis. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:293-300. [PMID: 33492189 DOI: 10.1080/19338244.2021.1874857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In spite of growing evidence for the negative effect of lead, knowledge about the dose-response relationship of maternal blood lead level (BLL) and the risk of small for gestational age (SGA) is limited. We performed this meta-analysis to evaluate the dose-response relation between maternal BLL and the risk of SGA. A systematic search through Embase and PubMed was performed. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated. The nonlinear and linear relationships between maternal BLL and the risk of SGA were also investigated. Results from 51,065 patients showed a significant association between maternal BLL and risk of SGA in highest versus lowest analysis (OR: 1.54; 95% CI: 1.12-2.10, p = 0.007). While there was no association in linear dose-response (OR: 1.02; 95% CI: 1.00-1.04, p = 0.021) meta-analysis, a direct relationship was observed in the nonlinear model (nonlinearity p < 0.001). Results of this dose-response meta-analysis showed that maternal BLL higher than ∼ 0.3 µg/dL is directly associated with the risk of SGA.
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Affiliation(s)
- Ahmad Habibian Sezavar
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Bahman Pourhassan
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Rahimi Kakavandi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Morteza Abyadeh
- Department of Molecular Systems Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Raoufi A, Rahimi Kelarijani B, Ahadi HR, Hassani Derakhshandeh B, Nooroollahzadeh Z, Hajifathali A. Association of MTHFR C677T and A1298C Polymorphisms with Susceptibility to Chronic Lymphocytic Leukemia: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:83-92. [PMID: 34178766 PMCID: PMC8213616 DOI: 10.18502/ijph.v50i1.5074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The relation between methylenetetrahydrofolate reductase)MTHFR(polymorphisms and the risk of developing Chronic lymphocytic leukemia (CLL) is not still clear, while there are reports about the association of MTHFR C677T and A1298C polymorphisms with developing CLL, there are other reports that rolled out the association of MTHFR polymorphisms with developing CLL. Therefore herein we carried out this meta-analysis to clear the association of MTHFR polymorphisms with the risk of CLL, Methods: A comprehensive search was performed through PubMed, Scopus and Embase from inception to Aug 2020. Odds ratios (OR) with their corresponding 95% confidence intervals (CI) for five possible genetic models were calculated. Heterogeneity was evaluated using the Cochran Q test and the I2 statistic. Results: Totals of 1290 cases and 1887 controls for the C677T polymorphism and 1117 cases and 1256 controls for the A1298C polymorphism were included in our analysis. Analyzing the MTHFR C677T and A1298C polymorphisms genotypes showed an association between MTHFR polymorphism at A1298C under Allelic model and the risk of CLL (OR = 1.12, 95% CI = 1.01–1.25), however there was no association between MTHFR polymorphism at MTHFR C677T and risk of CLL. Conclusion: The risk of developing CLL might be associated with MTHFR polymorphism at A1298C under allelic model and not associated with MTHFR polymorphisms at C677T, However, further studies considering other factors such as age, gender, ethnicity, gene-gene interaction and environmental condition are needed to clear the true association of MTHFR polymorphisms with CLL.
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Affiliation(s)
- Atefeh Raoufi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behdad Rahimi Kelarijani
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Ahadi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Abbas Hajifathali
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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