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Gao T, Wang S, Zhu Z, Lin L, Luo Y, Lu M, Liao W. Components from Curcuma longa (Turmeric) Against Hepatobiliary Diseases Based on Gut-Liver Axis: Pharmacotherapeutic Properties and Potential Clinical Applications. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2024; 52:387-415. [PMID: 38490808 DOI: 10.1142/s0192415x24500162] [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: 03/17/2024]
Abstract
Turmeric is widely used worldwide, and there are many examples of its use in treating hepatobiliary diseases. The gut-liver axis is a bidirectional relationship between gut microorganisms and the liver that is closely related to the pathogenesis of hepatobiliary diseases. This review systematically summarizes the components of turmeric. It links the studies on turmeric affecting gut microorganisms to its effects on liver and biliary diseases to explain the potential mechanism of turmeric's regulation of the gut-liver axis. Besides, ethnopharmacology, phytochemicals, and clinical adverse events associated with turmeric have been researched. Furthermore, turmeric is a safe agent with good clinical efficacy and without apparent toxicity at a certain amount. By summarizing the influence of turmeric on the liver by regulating the gut-liver axis, especially the gut microbiota, it provides a preclinical basis for using turmeric as a safe and effective therapeutic agent for the prevention and treatment of hepatobiliary diseases based on the gut-liver axis. However, more efforts should be made to exploit its clinical application further.
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Affiliation(s)
- Tianhui Gao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Shuyi Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Zongping Zhu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Liting Lin
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Yirong Luo
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Meigui Lu
- Huachiew TCM Hospital, Bangkok 10100, Thailand
| | - Wan Liao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
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Jantawong C, Chamgramol Y, Intuyod K, Priprem A, Pairojkul C, Klungsaeng S, Dangtakot R, Pongking T, Sitthirach C, Pinlaor P, Waraasawapati S, Pinlaor S. Curcumin-loaded nanocomplexes alleviate the progression of fluke-related cholangiocarcinoma in hamsters. Cancer Nanotechnol 2023. [DOI: 10.1186/s12645-023-00155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Background
Curcumin-loaded nanocomplexes (CNCs) previously demonstrated lower toxicity and extended release better than is the case for free curcumin. Here, we evaluated the efficacy of CNCs against opisthorchiasis-associated cholangiocarcinoma (CCA) in hamsters.
Method
Dose optimization (dose and frequency) was performed over a 1-month period using hamsters, a model that is widely used for study of opisthorchiasis-associated cholangiocarcinoma. In the main experimental study, CCA was induced by a combination of fluke, Opisthorchis viverrini (OV), infection and N-nitrosodimethylamine (NDMA) treatment. Either blank (empty) nanocomplexes (BNCs) or different concentrations of CNCs (equivalent to 10 and 20 mg cur/kg bw) were given to hamsters thrice a week for 5 months. The histopathological changes, biochemical parameters, and the expression of inflammatory/oncogenic transcription factors were investigated. In addition, the role of CNCs in attenuating CCA genesis, as seen in an animal model, was also confirmed in vitro using CCA cell lines.
Results
The optimization study revealed that treatment with CNCs at a dose equivalent to 10 mg cur/kg bw, thrice a week for 1 month, led to a greater reduction of inflammation and liver injury induced in hamsters by OV + NDMA than did treatments at other dose rates. Oral administration with CNCs (10 mg cur/kg bw), thrice a week for 5 months, significantly increased survival rate, reduced CCA incidence, extent of tumor development, cholangitis, bile duct injury and cholangiofibroma. In addition, this treatment decreased serum ALP and ALT activities and suppressed expression of NF-κB, FOXM1, HMGB1, PCNA and formation of 8-nitroguanine. Treatment of CCA cell lines with CNCs also reduced cell proliferation and colony formation, similar to those treated with NF-κB and/or FOXM1 inhibitors.
Conclusion
CNCs (10 mg cur/kg bw) attenuate the progression of fluke-related CCA in hamsters partly via a NF-κB and FOXM1-mediated pathway.
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Wang H, Chen L, Cai Q, Wu S, Shen W, Hu Z, Huang W, Jin W. Formation, digestion properties, and physicochemical stability of the rice bran oil body carrier system. Food Chem 2023; 409:135283. [PMID: 36571900 DOI: 10.1016/j.foodchem.2022.135283] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Rice bran is a major by-product of rice processing with abundant nutrient content. Oil bodies (OBs), which are fat particles with unique physicochemical stability, are specialized organelles for the storage of oils and fats in plant tissues. In this study, we extracted OBs from rice bran, to evaluate the function of hydrophobic nutrients efficiently delivered by OBs. The carrier system was prepared by sonicating curcumin with medium chain triglycerides (MCT) into rice bran oil bodies (RBOBs). Emulsions comprising different RBOB mass fractions were characterized. The results showed that the highest encapsulation efficiency (EE, 87.67%), optimal particle size (190 nm), and best storage stability were achieved with the 1.5 wt% RBOBs. Based on activity evaluation data, the carrier system can achieve sustained oil release in the intestine and shows high bioaccessibility (61.04%; IC50 in Caco-2 cells was 77.21 μg/mL), which is important for promoting grain by-product utilization.
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Affiliation(s)
- Han Wang
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China
| | - Lu Chen
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China
| | - Qiaoyu Cai
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China
| | - Shuang Wu
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China
| | - Wangyang Shen
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China; Hubei Key Laboratory for Processing and Transformation of Agricultural Products, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China
| | - Zhongze Hu
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China; Hubei Key Laboratory for Processing and Transformation of Agricultural Products, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China
| | - Wenjing Huang
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China; Hubei Key Laboratory for Processing and Transformation of Agricultural Products, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China.
| | - Weiping Jin
- College of Food Science and Engineering, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China; Hubei Key Laboratory for Processing and Transformation of Agricultural Products, Wuhan Polytechnic University, Wuhan 430023, Hubei, PR China.
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Phytochemistry and Pharmacology of Medicinal Plants Used by the Tenggerese Society in Java Island of Indonesia. Molecules 2022; 27:molecules27217532. [DOI: 10.3390/molecules27217532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
The archipelagic country of Indonesia is inhabited by 300 ethnic groups, including the indigenous people of Tengger. Based on the reported list of medicinal plants used by the Tengger community, we have reviewed each of them for their phytochemical constituents and pharmacological activities. Out of a total of 41 medicinal plants used by the Tengerrese people, 33 species were studied for their phytochemical and pharmacological properties. More than 554 phytochemicals with diverse molecular structures belonging to different chemical classes including flavonoids, terpenoids, saponins and volatiles were identified from these studied 34 medicinal plants. Many of these medicinal plants and their compounds have been tested for various pharmacological activities including anti-inflammatory, antimicrobial, wound healing, headache, antimalarial and hypertension. Five popularly used medicinal plants by the healers were Garcinia mangostana, Apium graveolens, Cayratia clematidea, Drymocallis arguta and Elaeocarpus longifolius. Only A. graviolens were previously studied, with the outcomes supporting the pharmacological claims to treat hypertension. Few unexplored medicinal plants are Physalis lagascae, Piper amplum, Rosa tomentosa and Tagetes tenuifolia, and they present great potential for biodiscovery and drug lead identification.
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GUIMARÃES RR, OLIVEIRA MAD, OLIVEIRA HC, DORÓ SCOL, MACHADO LA, OLIVEIRA MCD. Turmeric powder in the diet of Japanese quails improves the quality of stored eggs. REVISTA BRASILEIRA DE SAÚDE E PRODUÇÃO ANIMAL 2021. [DOI: 10.1590/s1519-99402122052021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY This study evaluated the effect of turmeric powder (TP) on the productivity and egg quality of quails and on the quality of eggs stored at different temperatures for 7 or 14 d. Quails were distributed in three treatments that consisted of sorghum-based diets with 1.5% and 3% TP or zero TP inclusion, with five replicates for 84 d. Eggs were stored at ambient temperature or refrigerated for 7 or 14 d in a 3 × 2 × 2 factorial arrangement with three TP levels × two storage temperatures (ST) × two storage periods (SP). Inclusion of TP did not affect the performance of the quails or egg quality at 84 d. Interaction SP × ST influenced the height and diameter of yolk and albumen, and the Haugh unit value. Eggs of quails with a diet supplemented with 3% TP and stored for 14 d showed specific gravity similar to the eggs stored for 7 d, despite the TP supplementation. It was concluded that diets with 3% TP did not affect the performance and quality of fresh eggs but improved the quality of eggs stored for 14 d at ambient temperature.
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Rahman MT, Hasan M, Hossain MT, Islam MS, Rahman MA, Alam MR, Juyena NS. Differential efficacies of marigold leaves and turmeric paste on the healing of the incised wound in sheep. J Adv Vet Anim Res 2020; 7:750-757. [PMID: 33409322 PMCID: PMC7774798 DOI: 10.5455/javar.2020.g477] [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: 07/12/2020] [Revised: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: This study was undertaken to compare the curative efficacy of marigold leaf paste and turmeric paste on healing the incised wound in sheep. The study also determined the antimicrobial effects and histopathological changes in a wound’s healing process treated with these medicinal herbs. Materials and Methods: Surgical wounds (n = 18) were created aseptically in the skin of the flank region of six healthy sheep dividing them into three experimental groups. Follow-up data were taken up to day 21. Different morphological characteristics of the wound and wound contraction (length and width) were recorded weekly. Samples were collected on days 1, 2, and 3 to test the antimicrobial effects and on days 1, 3, and 7 for histopathological studies. Results: Treatment with marigold leaf paste and turmeric paste resulted in a swelled wound area of 11.78 ± 0.38 mm and 11.52 ± 0.27 mm, respectively. The wound areas were comparatively lower than that of the control group (11.44 ± 0.20 mm). Moreover, the least elevation (2.44 ± 0.12 mm) of the sutured line from the skin surface was noted and compared between the marigold leaf paste and normal saline (2.74 ± 0.13 mm). Bacterial colonies in the nutrient agar medium cultured with swabs from the normal saline-treated group’s wound area were found on day 1. On the contrary, bacterial colonies were absent on days 2 and 3 of treatment in the groups treated with both the paste of marigold leaves and turmeric. Less intense tissue reactions and higher keratinization of epithelium were shown in the group treated with marigold leaf paste than turmeric paste and saline-treated groups. Conclusion: Marigold leaf paste showed less tissue reaction and healed the wounds effectively. Thus, this paste could be used for the treatment of superficial wounds in sheep.
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Affiliation(s)
- Md Tuhinur Rahman
- Department of Surgery and Obstetrics, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh.,Department of Surgery and Radiology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Moinul Hasan
- Department of Surgery and Obstetrics, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh
| | - Muhammad Tofazzal Hossain
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh
| | - Md Sayedul Islam
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh.,Department of Microbiology and Public Health, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Md Ataur Rahman
- Department of Surgery and Radiology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Md Rafiqul Alam
- Department of Surgery and Obstetrics, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh
| | - Nasrin Sultana Juyena
- Department of Surgery and Obstetrics, Bangladesh Agricultural University, Mymensingh-2202, Bangladesh
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Preclinical Evidence of Curcuma longa and Its Noncurcuminoid Constituents against Hepatobiliary Diseases: A Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:8761435. [PMID: 32802138 PMCID: PMC7411463 DOI: 10.1155/2020/8761435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
Hepatobiliary disease currently serves as an important public health issue due to the fact that it is one of the major causes of death among economically active individuals and can easily progress to chronic diseases. Despite the development of vaccines and numerous drugs, a definite treatment remains lacking owing to different stages of the disease itself, its intricate pathogenesis, an effect uncertainty for long-term use, resistance, and side effects. Curcuma longa (C. longa), which belongs to the family Zingiberaceae and the genus Curcuma, has long been used not only as spice for curry or dye but also as a constituent of herbal formula for the treatment of different diseases due to its bioactive activities. Recently, many studies on the experimental results of C. longa have been published relative to hepatobiliary diseases such as fatty liver, hepatitis, cirrhosis, and tumors. Therefore, in this review, we aimed to summarize the pharmacological effects and underlying molecular mechanisms of C. longa and its four compounds, β-elemene, germacrone, ar-turmerone, and bisacurone, against hepatobiliary diseases. C. longa exhibited antioxidant, hepatoprotective, antisteatotic, anti-inflammatory, antifibrotic, antitumor, and cholagogic effects by regulating apoptosis, CYP2E1, Nrf, lipid metabolism-related factors, TGF-β, NF-κB, CYP7A1, and so on. In particular, β-elemene could be an attractive compound owing to its remarkable hepatoprotective, anti-inflammatory, antifibrotic, and antitumor activities. Altogether, the present review provides a preclinical basis for the efficacy of C. longa as an effective therapeutic agent for the prevention and treatment of hepatobiliary diseases, despite the need for further studies to establish the extraction conditions and separation of active constituents with high bioavailability, and warrants further evaluation in clinical trials.
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Wu PQ, Li B, Yu YF, Su PJ, Liu X, Zhang ZP, Zhi DJ, Qi FM, Fei DQ, Zhang ZX. Isolation, Characterization, and Possible Anti-Alzheimer's Disease Activities of Bisabolane-Type Sesquiterpenoid Derivatives and Phenolics from the Rhizomes of Curcuma longa. Chem Biodivers 2020; 17:e2000067. [PMID: 32154990 DOI: 10.1002/cbdv.202000067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/09/2020] [Indexed: 01/29/2023]
Abstract
One new bisabolane-type sesquiterpenoid, together with four known bisabolane-type sesquiterpenoid derivatives and seven phenolics, was isolated from the rhizomes of Curcuma longa. Their structures were elucidated by extensive spectroscopic (IR, HR-ESI-MS, and NMR) data analysis. The possible anti-Alzheimer's disease (AD) activities of the isolated compounds were also evaluated using Caenorhabditis elegans AD pathological model, and 1β-hydroxybisabola-2,10-dien-4-one had the highest possible anti-AD activity.
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Affiliation(s)
- Pei-Qian Wu
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Bing Li
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Yi-Fan Yu
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Pan-Jie Su
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Xu Liu
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Zong-Ping Zhang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - De-Juan Zhi
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Feng-Ming Qi
- State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Dong-Qing Fei
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
| | - Zhan-Xin Zhang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, P. R. China
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Henrotin Y, Malaise M, Wittoek R, de Vlam K, Brasseur JP, Luyten FP, Jiangang Q, Van den Berghe M, Uhoda R, Bentin J, De Vroey T, Erpicum L, Donneau AF, Dierckxsens Y. Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multicenter randomized placebo controlled three-arm study. Arthritis Res Ther 2019; 21:179. [PMID: 31351488 PMCID: PMC6661105 DOI: 10.1186/s13075-019-1960-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/17/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives Comparison of two doses of bio-optimized Curcuma longa extract (BCL) in the management of symptomatic knee osteoarthritis (OA). Methods A prospective, randomized, 3-month, double-blind, multicenter, three-group, placebo-controlled trial assessing Patient Global Assessment of Disease Activity (PGADA) and serum sColl2-1, a biomarker of cartilage degradation, as co-primary endpoints. Pain on visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and paracetamol/non-steroidal anti-inflammatory drug (NSAID) consumption were used as secondary endpoints. Results One hundred fifty patients with knee OA were followed for 90 days. Low and high doses of BCL showed a greater decrease of PGADA than placebo. Analysis of sColl2-1 showed in the placebo and BCL low-dose groups, but not in the BCL high-dose group, a transient but non-significant increase of sColl2-1 between T0 and T1. Thereafter, in all groups, sColl2-1 decreased between T1 and T3 (all p < 0.01), but no difference between the groups was found. Pain reduction at day 90 in the low- and high-dose BCL groups (− 29.5 mm and − 36.5 mm) was higher than that in the placebo (− 8 mm; p = 0.018). The global KOOS significantly decreased overtime, but changes were comparable across treatment arms. The ratio of patients with adverse events (AE) related to the product was similar in the placebo and treatment groups, but the number of AE linked to the product was higher in the high-dose BCL group compared to the placebo (p = 0.012). Conclusions BCL appeared safe and well-tolerated with no evidence of severe adverse effects. Efficacy analysis suggested positive trends for measurements of PGADA and serum levels of an OA biomarker and showed a rapid and significant decrease of pain in knee OA (Trial registration: ISRCTN, ISRCTN12345678. Registered 21 September 2016—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02909621?term=osteoarthritis+curcumin&rank=5—Evaluation of FLEXOFYTOL® Versus PLACEBO (COPRA) NCT02909621). Electronic supplementary material The online version of this article (10.1186/s13075-019-1960-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Y Henrotin
- Bone and Cartilage Research Unit, Arthropôle Liège, Institute of Pathology, Level 5, CHU Sart-Tilman, University of Liège, 4000, Liège, Belgium. .,Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium. .,Artialis SA, GIGA Tower, CHU-Sart-Tilman, 4000, Liège, Belgium.
| | - M Malaise
- Rheumatology Department, CHU Sart-Tilman, Liège, Belgium
| | - R Wittoek
- Rheumatology Department, UZ Gent, Ghent, Belgium
| | - K de Vlam
- Rheumatology Department, ZNA Jan Palfijn, Merksem, Belgium
| | - J-P Brasseur
- Rheumatology Department, CHU UCL Namur, Yvoir, Belgium
| | - F P Luyten
- Rheumatology Department, University Hospitals Leuven, Leuven, Belgium
| | - Q Jiangang
- Rheumatology and Physical Medicine Department, Hôpitaux Iris Sud, Bruxelles, Belgium
| | - M Van den Berghe
- Rheumatology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - R Uhoda
- Physical Medicine and Rehabilitation Department, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgium
| | - J Bentin
- Rheumatology Department, CHU Brugmann, Bruxelles, Belgium
| | - T De Vroey
- Physical Medicine, UZA, Antwerpen, Belgium
| | | | - A F Donneau
- Public health Science Department, University of Liège, Liège, Belgium
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