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Koike S, Saito Y, Ogasawara Y. Novel Fluorometric Assay of Antiglycation Activity Based on Methylglyoxal-Induced Protein Carbonylation. Antioxidants (Basel) 2023; 12:2030. [PMID: 38136150 PMCID: PMC10740428 DOI: 10.3390/antiox12122030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced glycation end products (AGEs), which can have multiple structures, are formed at the sites where the carbonyl groups of reducing sugars bind to the free amino groups of proteins through the Maillard reaction. Some AGE structures exhibit fluorescence, and this fluorescence has been used to measure the formation and quantitative changes in carbonylated proteins. Recently, fluorescent AGEs have also been used as an index for the evaluation of compounds that inhibit protein glycation. However, the systems used to generate fluorescent AGEs from the reaction of reducing sugars and proteins used for the evaluation of antiglycation activity have not been determined through appropriate research; thus, problems remain regarding sensitivity, quantification, and precision. In the present study, using methylglyoxal (MGO), a reactive carbonyl compound to induce glycation, a comparative analysis of the mechanisms of formation of fluorescent substances from several types of proteins was conducted. The analysis identified hen egg lysozyme (HEL) as a protein that produces stronger fluorescent AGEs faster in the Maillard reaction with MGO. It was also found that the AGE structure produced in MGO-induced in HEL was argpyrimidine. By optimizing the reaction system, we developed a new evaluation method for compounds with antiglycation activity and established an efficient evaluation method (HEL-MGO assay) with greater sensitivity and accuracy than the conventional method, which requires high concentrations of bovine serum albumin and glucose. Furthermore, when compounds known to inhibit glycation were evaluated using this method, their antiglycation activities were clearly and significantly measured, demonstrating the practicality of this method.
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Affiliation(s)
| | | | - Yuki Ogasawara
- Department of Analytical Biochemistry, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan; (S.K.); (Y.S.)
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Chen CY, Zhang JQ, Li L, Guo MM, He YF, Dong YM, Meng H, Yi F. Advanced Glycation End Products in the Skin: Molecular Mechanisms, Methods of Measurement, and Inhibitory Pathways. Front Med (Lausanne) 2022; 9:837222. [PMID: 35646963 PMCID: PMC9131003 DOI: 10.3389/fmed.2022.837222] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/21/2022] [Indexed: 12/19/2022] Open
Abstract
Advanced glycation end products (AGEs) are a series of stable compounds produced under non-enzymatic conditions by the amino groups of biomacromolecules and the free carbonyl groups of glucose or other reducing sugars commonly produced by thermally processed foods. AGEs can cause various diseases, such as diabetes, atherosclerosis, neurodegeneration, and chronic kidney disease, by triggering the receptors of AGE (RAGEs) in the human body. There is evidence that AGEs can also affect the different structures and physiological functions of the skin. However, the mechanism is complicated and cumbersome and causes various harms to the skin. This article aims to identify and summarise the formation and characteristics of AGEs, focussing on the molecular mechanisms by which AGEs affect the composition and structure of normal skin substances at different skin layers and induce skin issues. We also discuss prevention and inhibition pathways, provide a systematic and comprehensive method for measuring the content of AGEs in human skin, and summarise and analyse their advantages and disadvantages. This work can help researchers acquire a deeper understanding of the relationship between AGEs and the skin and provides a basis for the development of effective ingredients that inhibit glycation.
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Affiliation(s)
- Chun-Yu Chen
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
| | - Jia-Qi Zhang
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
| | - Li Li
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
| | - Miao-Miao Guo
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
| | - Yi-Fan He
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
| | - Yin-Mao Dong
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
| | - Hong Meng
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
| | - Fan Yi
- Beijing Key Laboratory of Plant Resources Research and Development, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic, China National Light Industry, Beijing Technology and Business University, Beijing, China.,Institute of Cosmetic Regulatory Science, Beijing Technology and Business University, Beijng, China
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Hosseini MS, Razavi Z, Ehsani AH, Firooz A, Afazeli S. Clinical Significance of Non-invasive Skin Autofluorescence Measurement in Patients with Diabetes: A Systematic Review and Meta-analysis. EClinicalMedicine 2021; 42:101194. [PMID: 34841236 PMCID: PMC8605318 DOI: 10.1016/j.eclinm.2021.101194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Advanced glycation end products (AGE), one of the main factors causing diabetic end-organ damage, accumulate in long half-life proteins, such as skin and cartilage collagen. AGE measurement may offer additional evidence to predict diabetic vascular complications. Skin autofluorescence (SAF) is suggested as a non-invasive, quick, and reliable method to measure tissue AGE level. The aim of this study was to review and evaluate evidence on the clinical validation of SAF measurement in diabetes mellitus (DM) patients. METHODS In this systematic review and meta-analysis, we searched "PubMed" (MEDLINE) and "Cochrane" databases from their inception to 10 August 2021 for observational studies concerning SAF measurement in diabetic patients. The following key terms were used in advanced searching: "Diabetes", "Diabetes Mellitus"," DM", "Glycation ", "Advanced Glycation End product", "AGE", "skin autofluorescence", "SAF". Published studies that included DM patients and estimated their AGE using SAF were considered eligible for meta-analysis. Articles that were editorials, study proposals, congress posters, or case reports and were not on human subjects were excluded. We used a random-effect models for meta-analyzing the clinical validation of SAF in DM with particular emphasis on chronic diabetes complications. FINDINGS We identified 881 records and twenty-nine records fulfilled our eligibility criteria and were included in the systematic review and meta-analysis. A statistically significant correlation was found between SAF and diabetes last HbA1c 0.21(0.13,0.28) in studies with substantial heterogeneity (I2=77.99%, p<0.05). Nevertheless, a significant positive association between SAF level and diabetic retinopathy (DR) [(OR= 1.05, 95% CI=1.03,1.08), (I2=63.78%, p<0.05)], diabetic peripheral neuropathy (DPN) [(OR= 1.11, 95%CI= 1.06,1.16), (I2=79.17%, p<0.05)], diabetic nephropathy (DNP) [(OR= 1.08, 95%CI: 1.05,1.11), (I 2 =65.36%, p<0.05)] and diabetic macrovascular events (D-MVE) [(OR=1.08, 95%CI=1.05,1.11) (I2=67.32, p<0.05)] were found. INTERPRETATION Our study confirmed the significance of SAF measurement as a non-invasive surrogate marker of DM micro and macrovascular complications. Skin AGE estimation may be a useful factor for the prediction and early detection of irreversible DM complications. More studies with larger populations and longer follow-up periods are required.
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Affiliation(s)
- Mahboobeh sadat Hosseini
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Zahra Razavi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Amir Houshang Ehsani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Science, Tehran, Iran
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Januszewski AS, Xu D, Cho YH, Benitez-Aguirre PZ, O'Neal DN, Craig ME, Donaghue KC, Jenkins AJ. Skin autofluorescence in people with type 1 diabetes and people without diabetes: An eight-decade cross-sectional study with evidence of accelerated aging and associations with complications. Diabet Med 2021; 38:e14432. [PMID: 33078416 DOI: 10.1111/dme.14432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 02/03/2023]
Abstract
AIM To measure skin autofluorescence in youth (<18 y.o.) and adults (≥18 y.o.) and to assess its relationship with type 1 diabetes, chronic complications and smoking. METHODS In a cross-sectional study (n = 383) skin autofluorescence was measured in 269 people with type 1 diabetes (67 with vascular complications) and 114 people without diabetes, covering eight decades of age. Associations of skin autofluorescence with demographics and traditional risk factors were assessed. RESULTS Skin autofluorescence increased with age in people with diabetes: for those with complications it increased by a mean ± se of 0.029 ± 0.003 arbitrary units per year (r = 0.76) and, for those without complications, it increased by 0.028 ± 0.002 arbitrary units (r = 0.77). These increases were higher than for people without diabetes, whose skin autofluorescence increased by 0.022 ± 0.002 arbitrary units (r = 0.78) per year (p = 0.004). Mean ±se age-adjusted skin autofluorescence was higher in people with diabetes complications vs people without diabetes complications (1.85 ± 0.04 vs 1.66 ± 0.02 arbitrary units) and people without diabetes (1.48 ± 0.03 arbitrary units; all P < 0.0001). Age-adjusted skin autofluorescence was higher in current smokers and recent ex-smokers vs non-smokers and longer-term ex-smokers (1.86 ± 0.06 vs 1.63 ± 0.02 arbitrary units; P = 0.0005). Skin autofluorescence area under the receiver-operating characteristic curve was 0.89 (95% CI 0.85-0.94) for retinopathy and 0.56 (95% CI 0.47-0.65) for nephropathy. CONCLUSIONS Skin autofluorescence increases with age, but faster in people with diabetes, particularly in those with complications and in smokers, consistent with accelerated aging. Skin autofluorescence may facilitate complication screening and prediction. Longitudinal studies are merited.
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Affiliation(s)
- A S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medicine, University of Melbourne, Fitzroy, NSW, Australia
| | - D Xu
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Engineering Science, University of Oxford, Visual Geometry Group, Oxford, UK
| | - Y H Cho
- Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - D N O'Neal
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medicine, University of Melbourne, Fitzroy, NSW, Australia
| | - M E Craig
- Children's Hospital at Westmead, Sydney, NSW, Australia
| | - K C Donaghue
- Children's Hospital at Westmead, Sydney, NSW, Australia
| | - A J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medicine, University of Melbourne, Fitzroy, NSW, Australia
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Lv J, Bao S, Liu T, Wei L, Wang D, Ye W, Wang N, Song S, Li J, Chudhary M, Ren X, Kong L. Sulforaphane delays diabetes-induced retinal photoreceptor cell degeneration. Cell Tissue Res 2020; 382:477-486. [PMID: 32783101 DOI: 10.1007/s00441-020-03267-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
Diabetic retinopathy (DR) is a serious neurodegenerative disease that is induced by hyperglycaemia. Oxidative stress, inflammation and endoplasmic reticulum (ER) stress are involved in the development of DR. Sulforaphane (SF) is widely found in cruciferous plants and has a protective effect against retinal neurodegeneration in diabetes, but the mechanism is unclear. In this study, we investigated the mechanism by which SF protects against photoreceptor degeneration in diabetes. In vivo, a mouse model of diabetes was established by streptozotocin (STZ) injection, and the mice were treated with/without SF. Electroretinography (ERG) and H&E staining were used to evaluate retinal function and morphology. In vitro, 661w cells were treated with AGEs with/without SF. Cell viability and apoptosis were analysed by CCK-8 assay and flow cytometry. The expression of proteins and genes was assessed by western blot and qRT-PCR. The amplitude of the a-wave was decreased and the morphology was changed in the diabetic mice, and these changes were delayed by SF treatment. The percentage of apoptotic cells was increased and the cell viability was decreased after the treatment of 661w cells with AGEs. Moreover, the expression of GRP78, Txnip and TNFα was increased, however, this increased expression was reversed by SF treatment via AMPK pathway activation. Taken together, these data show that SF can delay photoreceptor degeneration in diabetes, and the underlying mechanism is related to the inhibition of ER stress, inflammation and Txnip expression through the activation of the AMPK pathway.
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Affiliation(s)
- Jinjuan Lv
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Shuyin Bao
- Medical College, Inner Mongolia University for Nationalities, Tongliao, 028300, Inner Mongolia, China
| | - Tianhe Liu
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Limin Wei
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Dongming Wang
- Department of Anesthesia, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Weikang Ye
- Department of Anesthesia, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Nina Wang
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Shiyu Song
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Jiao Li
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Maryam Chudhary
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China
| | - Xiang Ren
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China.
| | - Li Kong
- Department of Histology and Embryology, College of basic medicine, Dalian Medical University, Dalian, 116044, Liaoning Province, China.
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Recent Advances and the Potential for Clinical Use of Autofluorescence Detection of Extra-Ophthalmic Tissues. Molecules 2020; 25:molecules25092095. [PMID: 32365790 PMCID: PMC7248908 DOI: 10.3390/molecules25092095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023] Open
Abstract
The autofluorescence (AF) characteristics of endogenous fluorophores allow the label-free assessment and visualization of cells and tissues of the human body. While AF imaging (AFI) is well-established in ophthalmology, its clinical applications are steadily expanding to other disciplines. This review summarizes clinical advances of AF techniques published during the past decade. A systematic search of the MEDLINE database and Cochrane Library databases was performed to identify clinical AF studies in extra-ophthalmic tissues. In total, 1097 articles were identified, of which 113 from internal medicine, surgery, oral medicine, and dermatology were reviewed. While comparable technological standards exist in diabetology and cardiology, in all other disciplines, comparability between studies is limited due to the number of differing AF techniques and non-standardized imaging and data analysis. Clear evidence was found for skin AF as a surrogate for blood glucose homeostasis or cardiovascular risk grading. In thyroid surgery, foremost, less experienced surgeons may benefit from the AF-guided intraoperative separation of parathyroid from thyroid tissue. There is a growing interest in AF techniques in clinical disciplines, and promising advances have been made during the past decade. However, further research and development are mandatory to overcome the existing limitations and to maximize the clinical benefits.
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Kunimoto M, Shimada K, Yokoyama M, Matsubara T, Aikawa T, Ouchi S, Shimizu M, Fukao K, Miyazaki T, Kadoguchi T, Fujiwara K, Abulimiti A, Honzawa A, Yamada M, Shimada A, Yamamoto T, Asai T, Amano A, Smit AJ, Daida H. Association between the tissue accumulation of advanced glycation end products and exercise capacity in cardiac rehabilitation patients. BMC Cardiovasc Disord 2020; 20:195. [PMID: 32326893 PMCID: PMC7178950 DOI: 10.1186/s12872-020-01484-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background Advanced glycation end products (AGEs) are associated with aging, diabetes mellitus (DM), and other chronic diseases. Recently, the accumulation of AGEs can be evaluated by skin autofluorescence (SAF). However, the relationship between SAF levels and exercise capacity in patients with cardiovascular disease (CVD) remains unclear. This study aimed to investigate the association between the tissue accumulation of AGEs and clinical characteristics, including exercise capacity, in patients with CVD. Methods We enrolled 319 consecutive CVD patients aged ≥40 years who underwent early phase II cardiac rehabilitation (CR) at our university hospital between November 2015 and September 2017. Patient background, clinical data, and the accumulation of AGEs assessed by SAF were recorded at the beginning of CR. Characteristics were compared between two patient groups divided according to the median SAF level (High SAF and Low SAF). Results The High SAF group was significantly older and exhibited a higher prevalence of DM than the Low SAF group. The sex ratio did not differ between the two groups. AGE levels showed significant negative correlations with peak oxygen uptake and ventilator efficiency (both P < 0.0001). Exercise capacity was significantly lower in the high SAF group than in the low SAF group, regardless of the presence or absence of DM (P < 0.05). A multivariate logistic regression analysis showed that SAF level was an independent factor associated with reduced exercise capacity (odds ratio 2.10; 95% confidence interval 1.13–4.05; P = 0.02). Conclusion High levels of tissue accumulated AGEs, as assessed by SAF, were significantly and independently associated with reduced exercise capacity. These data suggest that measuring the tissue accumulation of AGEs may be useful in patients who have undergone CR, irrespective of whether they have DM.
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Affiliation(s)
- Mitsuhiro Kunimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kosuke Fukao
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomoyasu Kadoguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Abidan Abulimiti
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Andries J Smit
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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